eMOM: enhanced Monitoring to Optimize Maternal Diabetes detection

项目摘要/摘要 在美国，每年有超过25万名妇女患上妊娠期糖尿病(GDM)， 影响6.4%的怀孕。目前诊断妊娠期糖尿病的方法还没有进行。 直到第二个月末或第三个月初；然而，它可能是血糖异常 导致母亲和新生儿的不良结局早在这个黄金出现之前就已经出现了 标准筛查。凭借最新一代的连续血糖监测仪(CGM)， 能够收集准确的数据，不需要手指棒校准，并且可以 舒适的佩戴足够长的时间来捕捉血糖动态现在是可行的。现在 该提案寻求通过以下方式纵向评估健康、非糖尿病孕妇的血糖 使用盲法CGM数据收集，从6-12周开始，间隔4周 怀孕了。这些数据将允许确定传感器平均血糖水平的差异 患有妊娠期糖尿病的女性与不使用标准口腔护理的女性之间存在差异 糖耐量试验(OGTT)筛选。此外，随着CGM数据的频率 收集时，首先检测平均传感器血糖水平差异的最佳时间可以是 探索过了。最后，将进行更严格的OGTT，以评估 代谢异常是诊断妊娠期糖尿病的基础，包括血糖异常是否 是由于胰岛素抵抗或β细胞功能障碍。利用一个财团进行 目前的研究，一个大的队列是可行的，这将允许评估可能 导致血糖紊乱和妊娠期糖尿病的风险，包括种族/民族、孕前体重指数、 孕妇的年龄、产次和孕期体重增加。这项研究的发现可能会提供 如果盲目的CGM可以取代OGTT，我们诊断GDM的方式将发生范式转变 以及对导致诊断妊娠期糖尿病的代谢变化的了解。

Project Summary/Abstract Over 250,000 women develop gestational diabetes mellitus (GDM) each year in the U.S, affecting 6.4% of all pregnancies. Current methods for the diagnosis of GDM are not conducted until the end of the second or early in the third trimester; however, it is possible dysglycemia leading to both adverse maternal and neonatal outcomes are present well before this gold standard screening. With the newest generation of continuous glucose monitors (CGM), the ability to collect accurate data that does not require fingerstick calibration and can be comfortably worn long enough to capture glucose dynamics is now feasible. The present proposal seeks to longitudinally assess glycemia in healthy, non-diabetic pregnant women by using blinded CGM data collection in 4-week intervals beginning between 6-12 weeks’ gestation. These data will allow for determination if a difference in mean sensor glucose levels exists between women who develop GDM vs. those who do not using standard of care oral glucose tolerance test (OGTT) screening. Furthermore, with the frequency of CGM data collection, the optimal time to first detect the difference in mean sensor glucose levels can be explored. Finally, more rigorous OGTTs will be conducted allowing for assessment of the metabolic abnormalities that underlie the diagnosis of GDM including whether the dysglycemia is due to insulin resistance or β-cell dysfunction. With the use of a consortium to conduct the present study, a large cohort is feasible which will allow for assessment of factors that may contribute to risk of dysglycemia and GDM, including race/ethnicity, pre-pregnancy BMI, maternal age, parity and weight gain during pregnancy. The findings of this study may provide a paradigm shift in how we diagnose GDM if blinded CGM can be used in place of an OGTT and understanding of the metabolic alterations that lead to diagnosis of GDM.