Discussion
LGA, macrosomia, ’ consciousness, weight gain, GDM, hyperglycemia, hypoglycemia, diabetes complications
ADVERSE EVENTS, PREGNANCY COMPLICATIONS, PREMATURE DELIVERY, GDM, HYPERGLYCEMIA, HYPOGLYCEMIA
In this study, we assessed the effect of CGM application compared with SMBG in GDM patients with HbA1c levels <6%. There was no difference in GV, HbA1c levels or perinatal adverse events between the use of CGM and SMBG. However, the CGM group showed better gestational weight control and a lower birth weight of newborns. Concerning the high costs and comparable outcomes in glucose control and pregnancy complications with CGM in GDM patients, SMBG is recommended for those mild GDM patients (HbA1c levels <6%). However, the long-term effect of appropriate weight gain during gestation GV appears to be associated with the development of diabetes complications and has a significant impact on quality of life (Meanwhile, CGM examination might improve patients’ consciousness of self-management for better weight control. Our results demonstrated that compared to the SMBG group, the proportion of the within GWG recommendation group was higher in the CGM group. In addition, our results favored a significant reduction in neonatal birthweight in the CGM group, but the proportions of macrosomia, LGA and SGA were not different. A study showed that excessive weight gain occurred in 31.8% of GDM women (Our study showed that insulin use in the CGM group was higher than that in the SMBG group, but the difference was not significant. Previous findings have shown that insulin use was more common in the CGM group than in the SMBG group, which demonstrated the advantages of CGM in the accurate detection of hyperglycemia and hypoglycemia (This study had some strengths and limitations. The strengths of the trial included the high adherence to group assignment and a protocol practical in clinical practice. Assignment could not be blinded because of the nature of the intervention, but the groups had a similar number of visits. This study focused on the effect and cost between CGM and SMBG in GDM patients with HbA1c<6%. The TIR and other metrics in the two groups reflected well-controlled blood glucose levels in all participants. However, our study also had several limitations. Although every effort was made to ensure complete datasets, this was not achieved because of missing or lost samples. The main reasons included premature delivery, referral to another hospital and the COVID-19 outbreak. However, the percentage of missing data (19.4%) fell within the prespecified power calculation assumptions. In addition, all the patients who enrolled had HbA1c levels lower than 6.0%; therefore, our results may not apply to individuals with GDM who have HbA1c levels higher than 6.0%. In addition, the long-term effects of maternal GWG and birth weight on children remain to be studied.In conclusion, our data showed that for GDM patients with HbA1c less than 6%, regular SMBG is a more economical blood glucose monitoring method and can achieve similar performance as CGM in glycemic control and perinatal outcomes, while CGM is beneficial for ideal GWG.