BACKGROUND AND PURPOSE:

• Women with gestational diabetes (GDM) will usually self-monitor with 4-times-daily self-measurements
  • Evidence is limited that 4-times-daily self-measurement is a superior approach
•  Bussière-Côté (Canadian Journal of Diabetes, 2019) sought to determine whether twice-daily capillary blood glucose (BG) testing is comparable with 4-times-daily testing in women with GDM

METHODS:

• Retrospective cohort study
• Participants
  • Women with GDM
• Study design
  • Initial dietary counseling
  • At least 2 consecutive weeks of recorded consecutive fasting and 2-h postprandial BG self-measurements
  • Random selection of 2 of 4 BG measurements on each given day
• Statistical analysis
  • Comparison of 14-day means (95% CI) for twice-daily vs 4-times-daily BG measurements
  • The proportion of 14-day BG measurements (%, 95% CI) above glycemic targets was also compared between twice-daily vs 4-times-daily testing for fasting and postprandial readings
  • Data was also stratified based on the presence of insulin therapy

RESULTS:

• 32 women with GDM were included
  • Mean age: 33 years
  • Most women were either of South Asian (37.5%) or Western/European ancestry (25%)
  • 50% were treated with insulin
• When comparing twice-daily vs 4-times-daily mean BG, there was a small increase (0.09 mmol/L) in fasting BG
• There was no difference between 2 and 4-times measurement for  
  • 2-h postbreakfast BG (−0.05 mmol/L; 95% CI, −0.17 to 0.06)
  • 2-h postlunch BG (−0.03 mmol/L; 95% CI, −0.13 to 0.08)
  • 2-h postdinner BG (0.05 mmol/L; 95% CI, −0.09 to 0.19)
• The was general agreement between twice-daily vs 4-times-daily BG, whether fasting or postprandial
• There was no significant difference in the proportion of 14-day BG measurements above glycemic targets when comparing twice-daily vs 4-times-daily testing in the fasting or postprandial states

CONCLUSION:

• The results of this pilot study suggest in the setting of GDM, BG average values were similar whether patients were self-monitoring BG twice-daily or 4-times-daily
• The authors suggest if BG in the target range, twice-daily BG monitoring may be a reasonable approach, reducing cost and inconvenience

Learn More – Primary Sources:

Twice-Daily vs 4-Times-Daily Glucose Testing in Women With Gestational Diabetes Mellitus: A Pilot Study

Related ObG Topics:

Updated ACOG Guidance on Gestational Diabetes

When to Start Medications for Women Who are on Dietary Therapy for Gestational Diabetes?

ACOG and SMFM Both Release Guidance on Gestational Diabetes – Insulin vs Metformin for First-Line Therapy?