Dutch researchers say that treatment of diabetes in pregnant women should be aimed at achieving A1C levels within the range of 6% or less. They add that “a minimum of 10 self-monitored blood glucose determinations daily is necessary to obtain adequate information of all daily glucose fluctuations.”
Pregnancies in women with type 1 have been associated with complications despite keeping A1Cs at the ADA-recommended level of 7% or less. Against this background, the researchers sought to answer two questions:
- Are A1C levels within 1% above normal appropriate in pregnant women with type 1 diabetes, or should treatment be aimed at normal A1C levels?
- How many self-monitored blood-glucose (SMBG) levels are needed per day to obtain an adequate image of [blood glucose] control in pregnant women with type 1 diabetes?
The researchers asked 43 pregnant women with type 1 to use the continuous glucose monitoring system (CGMS) once in each trimester of pregnancy while continuing their SMBG measurements. Glucose levels measured with the CGMS were compared between patients with A1C levels of 4% to 6%, 6% to 7% and greater than 7%.
It was discovered that in patients with A1Cs less than 6%, the glucose levels obtained by CGMS were significantly better than in patients with A1Cs greater than 6%.
“In women with A1C levels of 6% to 7% and [greater than] 7%, these levels did not differ,” say the researchers. “The detection rate of hyper- and hypoglycemic episodes was significantly higher in patients with 10 or more SMBG determinations daily than in patients with fewer than 10.”
—Diabetologia, December 2005