Since 1980, the number of individuals with diabetes has nearly quadrupled to 422 million, almost all residing in developing nations. Overweight and obesity are among the factors fueling this significant growth. Diabetes mellitus has three primary divisions: type 1, type 2, and gestational diabetes. Pregnancy-related diabetes mellitus (GDM) is a significant problem in Malaysia and other Asian nations.
This guide covers how this condition affects Malaysian women, its causes, the role of CGM (Continuous Glucose Monitoring), and the importance of monitoring blood glucose concentration.
Understanding Gestational Diabetes Mellitus
Gestational diabetes is a pregnancy-related disorder that raises the mother’s chance of developing type 2 diabetes after delivery. In other words, when a woman’s sugar levels go above average but not yet high enough to be considered diabetic, she is said to have gestational diabetes.
Hence, gestational diabetes mellitus” (GDM) indicates any level of diabetes that initially manifests or is discovered during pregnancy. Worldwide, GDM is one of the major causes of maternal and newborn morbidity. But these aren’t the only problems of gestational diabetes in pregnancy. Malaysian women who have GDM are more likely to have diabetes complications during pregnancy, including miscarriage, high blood pressure, preeclampsia, and the need for a cesarean surgery.
Not only that, but women who have had GDM before are also much more likely to get type 2 diabetes mellitus (T2DM) and heart disease in the future. Furthermore, Women with gestational diabetes mellitus (GDM) carry an increased risk of macrosomia, congenital anomalies, neonatal hypoglycemia, and type 2 diabetes (T2DM) in later life. Hence, policymakers in the healthcare sector must be aware of the gravity of GDM if they are to implement effective measures to diagnose and treat it at its earliest stages.
The Importance of Maternal and Fetal Health
Like most medical conditions, ensuring optimal health is the first action against GDM. Thus, maternal and fetal health in Malaysia is essential to reducing fatalities and complications caused by this condition. However, one may ask, “What is maternal health?”
Understanding Maternal Health
“Maternal health” refers to mothers’ mental and physical well-being during pregnancy and after delivery. Pregnancies, labor, and deliveries must be all safe, healthy experiences for mothers and their babies. Not only is maternal health care vital to moms and babies, but it’s also essential for society. That’s because maternal health impacts the well-being of future generations. In other words, a community can be profoundly affected by whether or not women have access to proper health care.
What is Fetal Health?
Fetal health refers to the state of the developing embryo’s physical and mental well-being from conception until birth. It encompasses all aspects of the developing infant, including physical, mental, and domestic health. Numerous factors, such as genetic makeup, environmental conditions, and maternal health, impact the development and health of the fetus.
The mother’s health during pregnancy is crucial to the growth and development of the unborn child and can have far-reaching consequences for the child’s future happiness and success.
Among the most critical reasons why fetal health is so important are the following:
Risk of Congenital Defects is Lower
Optimal Birth Weight
Having a sound mental state
Continuous Glucose Monitoring (CGM): An Overview
What Is a Continuous Glucose Monitor?
Continuous glucose monitoring entails using a device like AIDEX to measure your glucose level autonomously, also known as blood sugar, 24 hours a day. You can view the glucose level in your blood at any one time. You can also look at the trends in your blood sugar levels over a few hours or days.
With the help of AIDEX continuous glucose monitoring of your blood sugar, you may make better decisions about the food and drinks you eat, the amount of exercise you get, and the medications you take. Managing your diabetes by maintaining a healthy blood sugar level can reduce your risk of developing secondary complications.
How Does a CGM Monitor Blood Glucose Levels?
The AIDEX device records and calculates your blood glucose levels regularly. There are three constituents of a typical CGM. First, it has a small sensor with an adhesive patch to help it stay in place. It can be placed beneath your skin, usually on your arm or abdomen.
The CGM also has a transmitter as its second component. The data is wirelessly transmitted from the transmitter to software, such as a smartphone, to display the blood glucose data. an insulin pump like the Equil Patch Pump, or a third-party device.
Who Should Use a Continuous Glucose Monitor?
If you require insulin to control GDM diabetes or another kind of diabetes, your doctor could advise using a continuous glucose monitor (CGM). CGMs are prescribed by physicians to both adults and children. Certain types are suitable for toddlers as young as two years old.
Different Types of CGM
Although all continuous glucose monitoring devices estimate blood sugar levels, different devices store and present the data differently. Certain CGMs automatically transmit and show data to your receiver or smartphone. These CGMs are referred to as “real-time” CGM devices. Another form of CGM, known as intermittent scan, regularly calculates sugar levels.
Now, let’s find out why it’s instrumental in the fight against GDM.
Advantages of CGM in Pregnancy
Blood glucose levels rise in people with gestational diabetes, which causes excess glucose to cross the placenta and stimulate the pancreatic islets. The fetus responds to this stimulus by producing more insulin, which increases fetal protein and fat synthesis and contributes to the growth of a large baby. Furthermore, since the fetus has too much insulin, hypoglycemia is a common side effect of childbirth. After downloading blood sugar data from a CGM, you may find intriguing statistics, such as Glucose Variability (GV).
The conventional method for calculating GV involves determining the amplitude of glycemic excursions using data from CGM or self-monitored blood glucose (SMBG).
Hypoglycemia becomes more common if glucose is not administered promptly. Hyperglycemia and hyperinsulinemia can lower the surface-active substance of type II cells in the fetus’ lungs. This stops the fetal lungs from growing normally and can affect their development. This disorder may result in neonatal respiratory distress syndrome. Studies have demonstrated that CGM lowers unfavorable perinatal outcomes for mothers dealing with GDM.
In a prospective study, 77 women with GDM between 26 and 32 weeks of pregnancy had their blood glucose levels tracked using CGM for six days.
Maternal and fetal problems and pharmacological treatment were studied with the timing of hyperglycemia in the day, evening, and night. Macrosomia and births to large babies for their gestational age (LGA) were linked to TAR. For every 1% rise in TAR, the chance of needing drug treatment rose 24%. Patients with GDM can be quickly identified and given the appropriate medication using CGM to track their blood glucose levels. This preventative strategy can potentially cut down on the number of unfavorable pregnancy outcomes and fetal health, such as macrosomia.
So, can you have a safe pregnancy with gestational diabetes? Ultimately, most women dealing with GDM can have safe pregnancies and healthy babies if they can diagnose and treat their condition early, using a CGM to ensure the health of both themselves and their unborn children.
Glucose Variability: A Crucial Aspect
The term “glycemic variability” (GV) refers to variations in the amount of glucose found in the blood. New clinical data shows that GV is linked to a higher chance of microvascular complications, hypoglycemia, and death in patients with diabetes, regardless of their glycated hemoglobin level. The adoption of continuous glucose tracking devices has drastically improved the evaluation of GV in clinical settings and made it easier to evaluate GV and high and low blood sugar events in diabetes patients.
Improved methods for determining GV in diabetic patients have been available since the debut of CGM devices in 1999. CGM sensors detect interstitial glucose concentration every 1-5 minutes, eliminating any need for repeated capillary SMBG and considerably enhancing data on glucose swings and trends.
CGM vs. Traditional Blood Sugar Tests
Many people with diabetes constantly monitor their blood sugar levels using a reliable blood sugar meter or a fingerstick blood test. You can use fingerstick reading to get an estimate of your blood sugar level when you check it. Most people have to use it multiple times daily for a clearer picture of their glucose levels.
However, CGMs elevate the process of monitoring blood sugar to an entirely new level. They monitor subcutaneous glucose levels instead of the blood. You insert a microscopic sensor under the skin of your abdomen or arm using an applicator. It is held in position by a strip of tape. Although there are distinctions between models, the vast majority wirelessly transmit your readings to your smartphone through an app.
Which is more accurate: a CGM or a Blood Glucose Meter?
One of your top priorities while doing a blood glucose test should be ensuring that the results are reliable. Blood glucose meters are subject to rigorous FDA regulations. Stats show that blood glucose meters have an accuracy rate of 95% within 15% for every measurement in the “usable” range and 99% precision within 20%. Usable refers to the spectrum of blood sugar values for which the meter’s accuracy has been demonstrated.
On the other hand, the accuracy of your CGM reading depends on several factors, like the device’s calibration, the sensors’ chemical composition, and the user’s body chemistry. Thus providing highly accurate readings and statistical data that can prove instrumental in effective treatment.
The Malaysian Context
GDM is thought to affect between 1% and 28% of pregnant women around the world, and in 15 multinational centers, the overall prevalence of GDM was 17.8%. Meanwhile, the bulk of (GDM) in Malaysia has been estimated to be between 18.3% and 24.9%, according to two separate studies.
Nevertheless, current information on GDM among pregnant women receiving prenatal treatment at a public health facility in Malaysia is lacking. For instance, in Selangor, public health offices only check for GDM in people with risk factors. If there are no contraindications, screening with a 75g oral glucose tolerance test (OGTT) is performed once at 24 weeks into gestation. The World Health Organization (WHO) also suggests screening for diabetes in pregnant women at their first prenatal appointment and again between 24 and 28 weeks of pregnancy.
From 2006-2011, DM among Malaysian adults rose from 11.6% to 15.2%. As a result, it is anticipated that GDM prevalence will increase as well.
Practical Aspects of Using CGM
Like every other medical device, a CGM must have certain essential parts and qualities to properly function. Some of these various practical aspects include the number of parts, their sizes, how long users can wear the sensor, the insertion method, and usability.
Let’s take a closer look at each.
Sensor Lifetime, Sensor Size, and the Total Number of Parts
Certain CGMs need patients to bring their blood glucose meter, receiver, and insulin administration supplies. Also, users of insulin pumps must know that RT-CGM systems require a second insertion site.
Insertion of Sensors
Your ability to effectively employ an RT-CGM device may depend on the insertion procedures. The sensors for the AIDEX CGM and the design of the Equil Patch Insulin Pump are simpler to use since they come preloaded into their insertion delivery units.
User-friendly design
All CGM systems provide continuous glucose sensing—however, some call for more user input than others.
Insertion Pain / Difficulty
It is crucial to allow patients to study and practice sensor insertions with a competent physician because each CGM system type has unique sensor insertion quirks. Patients and caregivers may need multiple training sessions to feel confident about insertion methods. You should put the sensors where you can “pinch” and raise some body fat.
Where in Malaysia Can I Purchase a CGM?
Don’t hesitate to ask your primary healthcare providers all the necessary questions regarding CGM or contact NMC Healthcare. You can request a quote for the AIDEX continuous glucose monitoring or Equil Patch Insulin Pump.
Conclusion
Several variables, including urbanization, lifestyle changes, an unfavorable hyperglycemic intrauterine environment, and the consequent epigenetic modifications, have been linked to the dramatic rise in the incidence of gestational diabetes mellitus (GDM). Fortunately, patients with more severe illnesses and an increased risk of unfavorable maternal-fetal results benefited from CGM’s ability to boost glycemic control without experiencing a spike in symptomatic hypoglycemia.
However, healthcare is personal, and you’ll need to approach your treatment and management of diabetes as such. Therefore, you must learn more about CGMs, their prices, features, and how they work by exploring our Continuous Glucose Monitor on NMC Healthcare.
References
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-2131-4
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-12-23
https://www.mdpi.com/1660-4601/18/3/1272
https://pesquisa.bvsalud.org/portal/resource/pt/wpr-626613
https://pubmed.ncbi.nlm.nih.gov/19465232
https://pubmed.ncbi.nlm.nih.gov/14958933/
https://www.who.int/health-topics/maternal-health
https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
https://academic.oup.com/book/11536/chapter-abstract/160318614?redirectedFrom=fulltext
https://pubmed.ncbi.nlm.nih.gov/14166677/
