No benefit of very tight glycemic control on pregnancy outcomes in gestational diabetes
medwireNews: Findings from a randomized controlled trial indicate that very tight glycemic control does not improve pregnancy outcomes for women with gestational diabetes.
Current glycemic goals for the management of gestational diabetes vary “because there is scant evidence on [the association between] glucose levels in pregnancy and pregnancy outcomes,” lead researcher Polina Popova (Almazov National Medical Research Centre, Saint Petersburg, Russian Federation) told delegates at the 54th EASD Annual Meeting in Berlin, Germany.
“The aim of our study was to assess the effect of different intensities of glycemic control […] on maternal and infant health outcomes,” she added.
The researchers randomly assigned women with gestational diabetes who were in week 12–31 of pregnancy to undergo diet and lifestyle changes with target blood glucose levels of either below 5.1 mmol/L (92 mg/dL; very tight control group) or below 5.3 mmol/L (95 mg/dL; comparison group). The target values for postprandial glucose levels were below 7.0 mmol/L (126 mg/dL) and 7.8 mmol/L (140 mg/dL), respectively.
Popova explained that insulin treatment was recommended for very tight control participants whose glucose measurements exceeded target levels in two or more measurements per week, and in patients from the comparison group with glucose levels above target in at least three measurements per week.
In all, 32% of 244 patients in the very tight control group met their glucose target, as did 68% of 232 women in the comparison group. Additionally, 18% of patients in the comparison group achieved very tight glucose control, while 83% of those aiming for very tight control met the glucose target set for the comparison group.
But there was no significant difference in the primary outcome of proportion of large for gestational age (LGA) infants born to women from the very tight control and the comparison groups, with rates of 14.3% and 16.4%, respectively.
Similarly, rates of other outcomes including macrosomia, neonatal hypoglycemia, cesarean delivery, and preeclampsia were also comparable between the two groups, as was the average gestational age at birth and birthweight.
The findings were similar when the analysis was restricted to participants who achieved target glucose levels according to their group allocation.
Therefore, “striving for very tight target glycaemic levels” in women with gestational diabetes does not improve pregnancy outcomes, said Popova.
She emphasized, however, that having tighter glycemic targets resulted in a “considerably higher” proportion of patients requiring insulin therapy. Approximately half of patients in the very tight control group, and approximately a quarter of those in the comparison group, started insulin during the trial.
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