Journal
DIABETOLOGIA
Volume 60, Issue 4, Pages 618-624Publisher
SPRINGER
DOI: 10.1007/s00125-017-4205-7
Keywords
Average glucose; Continuous glucose monitoring; Estimated average glucose; Gestation; HbA(1c); Pregnant; Type 1 diabetes; Type 2 diabetes
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Funding
- Ipswich Diabetes Centre Charity Research Fund
- National Institute for Health Research [CDF-2013-06-035]
- European Foundation for the Study of Diabetes and LifeScan
- Rigshospitalet's Research Foundation
- Capital Region of Denmark
- Medical Faculty Foundation of Copenhagen University
- Aase and Ejnar Danielsen's Foundation
- Master joiner Sophus Jacobsen and wife Astrid Jacobsen's Foundation
- Novo Nordisk Foundation
- National Institute for Health Research [CDF-2013-06-035, PDF/01/036] Funding Source: researchfish
- Novo Nordisk Fonden [NNF14OC0009275] Funding Source: researchfish
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Aims/hypothesis This study aimed to examine the relationship between average glucose levels, assessed by continuous glucose monitoring (CGM), and HbA(1c) levels in pregnant women with diabetes to determine whether calculations of standard estimated average glucose (eAG) levels from HbA1c measurements are applicable to pregnant women with diabetes. Methods CGM data from 117 pregnant women (89 women with type 1 diabetes; 28 women with type 2 diabetes) were analysed. Average glucose levels were calculated from 5-7 day CGM profiles (mean 1275 glucose values per profile) and paired with a corresponding (+/- 1 week) HbA1c measure. In total, 688 average glucose-HbA(1c) pairs were obtained across pregnancy (mean six pairs per participant). Average glucose level was used as the dependent variable in a regression model. Covariates were gestational week, study centre and HbA1c. Results There was a strong association between HbA1c and average glucose values in pregnancy (coefficient 0.67 [95% CI 0.57, 0.78]), i.e. a 1% (11 mmol/mol) difference in HbA1c corresponded to a 0.67 mmol/l difference in average glucose. The random effects model that included gestational week as a curvilinear (quadratic) covariate fitted best, allowing calculation of a pregnancy-specific eAG (PeAG). This showed that an HbA1c of 8.0% (64mmol/mol) gave a PeAG of 7.4-7.7mmol/l (depending on gestational week), compared with a standard eAG of 10.2 mmol/l. The PeAG associated with maintaining an HbA1c level of 6.0% (42 mmol/mol) during pregnancy was between 6.4 and 6.7 mmol/l, depending on gestational week. Conclusions/interpretation The HbA1c-average glucose relationship is altered by pregnancy. Routinely generated standard eAG values do not account for this difference between pregnant and non-pregnant individuals and, thus, should not be used during pregnancy. Instead, the PeAG values deduced in the current study are recommended for antenatal clinical care.
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