medwireNews: More than a third of women with gestational diabetes mellitus (GDM) are failing to self-monitor their postprandial blood glucose levels, with possible implications for pregnancy outcomes, according to a French pilot study.
Over a mean of 13 days, only 61.5% of 91 prospectively selected French-speaking women with newly diagnosed GDM were considered to be compliant with the recommended daily monitoring, having performed at least 80% of the required pre- and postprandial self-monitoring of blood glucose (SMBG) tests. In addition, only 42 (46.2%) women performed at least 80% of postprandial measurements within the recommended 100–140 min after eating.
These findings had consequences for pregnancy outcomes, with a 12.1% rate of preeclampsia among women with poor adherence to self-monitoring, compared with 1.9% among those with good adherence. Women with inappropriate timing of postprandial SMBG (ie, <100 or >140 min after the preprandial test) were more likely to need insulin therapy and to have higher glycated hemoglobin levels at delivery than those with adequate postprandial SMBG timing, at 28.9% and 5.3 mmol/mol versus 7.1% and 5.0 mmol/mol, respectively.
The study, published in Diabetes Care, found that adherence to self-monitoring was independently associated with a family history of diabetes, with the researchers suggesting: “We might guess that [these women] were less anxious about diabetes.”
Conducting postprandial SMBG at an appropriate time was independently associated with being of French origin, inadequate preprandial glucose control, lower compliance with SMBG testing, and lower concordance between logbook and glucose meter values.
Although pregnant women are generally considered to be highly motivated to follow recommended treatment guidelines, say the researchers, this study “show[s] that we need to improve motivation of women with GDM for SMBG, especially those with family history of diabetes for compliance and those not from France for adequate postprandial timing.”
The researchers describe concordance between logbook entries and results from glucose meters as “inadequate”, with 23.1% of women inaccurately recording their results.
Commenting on the clinical implications of this, Emmanuel Cosson (Université Paris 13, France) and study co-authors highlight that “using the memory of blood glucose meters or automatically generated diary from glucose meters should improve the assessment of blood glucose control and guide clinical management and therefore might improve prognosis.”
They conclude: “SMBG adherence and reliability are of concern and may be associated with poor gestational prognosis, suggesting that caregivers should systematically check the glucose meter memory to improve GDM management.”
By Catherine Booth
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