(190) Adopting Technology for Glucose Optimization and Lifestyle in Pregnancy (AT GOAL): A randomized control trial

This study aimed to assess the effect of use of continuous glucose monitors (CGMs) as well as patient satisfaction associated with their use among pregnant patients with type 2 diabetes (T2D).

Study Design:

In this randomized control trial, pregnant patients with T2D were randomized < 20 weeks’ gestation to standard finger stick blood glucose meters or CGMs from 8/2022 – 10/2024. Controls wore a blinded CGM on study entry and between 28-32 weeks for comparison. All participants answered quality of life surveys at set time points in the study. Qualitative, semi-structured interviews were conducted postpartum. Interviews were transcribed and analyzed using a descriptive inductive qualitative methodology. Statistical analysis included t-tests, Fisher's exact tests, and mixed effects longitudinal data analysis models.

Results:

16 patients enrolled in the study with similar baseline demographic data. Although not statistically significant, a clinically significant increase in time in range (TIR) occurred among the CGM group (8%) with a decrease in controls (-9%). In interviews, emergent themes were identified and a conceptual framework was developed. There was significant dissatisfaction with checking finger sticks multiple times per day with a negative impact on patient experience. Concerns included forgetting to check, discomfort, amount of time and lack of control over blood sugars. CGM alleviated some of this burden; patients found it reduced the stress associated with having diabetes in pregnancy. Additionally, CGM use allowed for identification of dietary patterns that influenced blood sugar levels, increasing feelings of control over their disease. Neither cost nor device accuracy were of concern.

Conclusion:

The burden of managing T2D in pregnancy is significant, and CGM appears to improve TIR, reduce burden on patients, and help patients feel in greater control. As CGM becomes more ubiquitous, these data support increased use of CGM in pregnancy to allow for greater individualized knowledge of blood sugar control with decreased stress of managing T2D. A larger randomized control trial is needed.