妊娠中の1型糖尿病患者における持続血糖測定の使用成績

Objective Continuous glucose monitoring (CGM) use among patients with type 1 diabetes (T1DM) has been associated with improved glycemic control, though improvement in non-glycemic outcomes is less consistent. We hypothesize that CGM use in patients with T1DM in a real-world clinical setting is associated with both improved glycemic and clinical outcomes. Study Design This was a retrospective cohort study of patients with T1DM receiving care at a large health system from 2016 to 2023. Primary outcomes included: 1) glycemic control and 2) a composite comprised of severe maternal morbidity, preeclampsia with severe features, delivery prior to 34 weeks, and admission for diabetic ketoacidosis. Primary glycemic outcome was Hb A1c < 6% in the 2nd trimester. Patients using CGM were then evaluated by device setting, with those set to targets consistent with American Diabetes Association (ADA) recommendations compared to those with more permissive goals. Adjusted odds ratios were calculated using multivariable logistic regression to adjust for potential confounding variables. Results Among 288 patients with T1DM, there were 145 deliveries in the CGM group and 143 in the traditional capillary blood glucose monitoring group. Midtrimester on-target glycemic control was improved in the CGM group compared to traditional monitoring (40.7% vs 17.5%, aOR 2.32; 95% CI 1.21-4.12). There was no difference in composite outcome (CGM: 42.8% vs TBGM: 49.0%, aOR 0.70; 95%CI 0.40-1.22), nor was there a difference in secondary outcomes. In patients using CGM, stricter targets were associated with improved glycemic control as well as reduced preterm delivery (18.8% vs 56.9%, aOR 0.16, CI 0.05-0.48) and NICU admission (37.5% vs 60%,aOR 0.37, CI 0.14-0.96). Conclusion CGM use in T1DM is associated with improved glycemic control throughout pregnancy, however this does not uniformly translate to improved clinical outcomes. Lack of adherence to ADA blood glucose targets may contribute to these findings.