Time Spent In Target Glucose Range in Women With T2D Diabetes in Pregnancy

Study Overview
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Brief Summary
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Prospective cohort study to determine to what extent women with type 2 diabetes are achieving the time in the target range outlined for women with type 1 diabetes (70-140 mg/dl or 3.5-7.8 mmol/l), overall and by trimester, by standard CGM measures and functional data analysis

Official Title
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Time Spent In the Target Glucose Range and MatErnaL and Neonatal Effects in Women With tYpe 2 Diabetes in Pregnancy (TIMELY)

Conditions
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Diabete Type 2, Pregnancy in Diabetic

Intervention / Treatment
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* Device: Dexcom Continuous Glucose Monitoring


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women with type 2 diabetes diagnosed prior to pregnancy or prior to 20 weeks gestation with either a HbA1c of >6.5%, fasting glucose ≥7.0, or 2 hr glucose ≥11.1 on a 75g OGTT. To make the diagnosis in pregnancy one needs 2 values equal to or greater than the values above. ≤14 weeks gestation, age ≥18 years Willingness to use the study devices a minimum of 10 days per trimester Able to provide informed consent Have access to email Exclusion Criteria: Non-type 2 diabetes Current treatment with drugs known to interfere with glucose metabolism as judged by the investigator such as high dose systemic corticosteroids Known or suspected allergy against insulin Women with nephropathy (eGFR<30), severe autonomic neuropathy, uncontrolled gastroparesis that, as judged by the investigator, is likely to interfere with the normal conduct of the study and interpretation of study results Severe visual or hearing impairment, as judged by the investigator to impact treatment compliance Unable to communicate effectively in English as judged by the investigator Any reason judged by the investigator that would likely interfere with the normal conduct of the study and interpretation of study results

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: Dexcom Continuous Glucose Monitoring|A continuous glucose monitor (CGM) is a wearable device that tracks blood glucose (sugar) every few minutes, throughout the day and night. The readings are relayed in real time to a device which can be read by the patient, caregiver or health-care provider, even remotely|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time in target range | To determine to what extent women with type 2 diabetes are achieving the time in the target range outlined for women with type 1 diabetes (70-140 mg/dl or 3.5-7.8 mmol/l), overall and by trimester, by standard CGM measures and functional data analysis | 7-9 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Delivery outcome | delivery outcome will be reported as ,full term birth, pre-term birth, spontaneous abortion, miscarriage or termination. | 7-9 months | 
| Maternal outcome | Date and time of hospital admission for delivery and discharge. | 7-9 months | 
| Maternal outcome (HTN) | Maternal postpartum diagnosis of hypertension or pre-eclampsia. | 7-9 months | 
| Neonatal weight at birth | Neonatal weight measurement collected from medical chart. | 7-9 months (Delivery of neonate) | 
| Neonatal outcomes (hypoglycemia) | Proportion of babies born with hypoglycemia. The lowest recorded glucose value (mmol/L) will be collected for babies born with hypoglycemia | 7-9 months (Delivery of neonate) | 
| Neonatal outcomes (chromosomal abnormality) | Proportion of babies born with chromosomal abnormality and type of chromosomal abnormality | 7-9 months (Delivery of neonate) | 
| Neonatal outcomes (congenital anomaly) | Proportion of babies born with congenital anomaly and type of congenital anomaly | 7-9 months (Delivery of neonate) | 
| Neonatal outcomes (birth injury) | Proportion of babies born with neonatal birth injury and type of injury | 7-9 months (Delivery of neonate) | 
| Neonatal outcomes (hyperbilirubinemia) | Proportion of babies born with neonatal hyperbilirubinemia requiring treatment (• phototherapy > 6 continuous hours, an exchange transfusion, intravenous gamma globulin or required re-admission into hospital during the first 7 days of life) | 7-9 months (Delivery of neonate) | 
| Neonatal outcomes (neonatal intensive care admission) | Proportion of babies admitted to neonatal intensive care admission | Delivery of neonate to 6 weeks postpartum | 
| Covariates (maternal obesity) | maternal weight will be collected/measured | 16-24 weeks gestation, 34 weeks gestation, 4-6 weeks postpartum | 
| Covariates (maternal ethnicity) | maternal ethnicity will be collected | Enrollment (16-24 weeks gestation) | 
| Covariates (Mother's total household income) | total household income will be collected | enrollment 16-24 weeks gestation | 
| Adverse events | Adverse events description and time of occurrence will be recorded when applicable | 7-9 months | 
| Blood Insulin | blood insulin measured in pmol/L. | at 16-24 weeks gestation | 
| Measures of insulin resistance (HOMA-IR ) | Homeostatic Model Assessment for Insulin Resistance ( HOMA-IR ) index will be calculated suing blood insulin and blood glucose | at 16-24 weeks gestation | 
| Mean blood glucose measurement | Blood glucose measured in mmol/L | at 16-24 weeks gestation | 
| Diabetes distress | Using Diabetes Distress Screening Scale (DDSS17). The scale yields an overall distress score based on the average of response on the 1-6 scale for all 18 items. The DDS-17 identifies three levels of specificity of diabetes distress information for use in clinical care, from overall emotional distress related to diabetes to highly specific sources of diabetes distress. Higher score is worse. | at 16-24 weeks gestation and at 34 weeks gestation | 
| Sleep quality | Using the Berlin Questionnaire. The Berlin Questionnaire consists of three categories designed to elicit information regarding snoring (category 1), daytime somnolence (category 2), and the presence of obesity and/or hypertension (category 3). Categories 1 and 2 are considered positive if 2 or more responses are positive category 3 is considered positive if 1 response is positive and/or the body mass index is greater than 30 kg per meter squared. A patient is considered to have a high likelihood of sleep disordered breathing if 2 or more categories are positive | at 16-24 weeks gestation and at 34 weeks gestation | 
| Sleep apnea | Using the Berlin Questionnaire. The Berlin Questionnaire consists of three categories designed to elicit information regarding snoring (category 1), daytime somnolence (category 2), and the presence of obesity and/or hypertension (category 3). Categories 1 and 2 are considered positive if 2 or more responses are positive category 3 is considered positive if 1 response is positive and/or the body mass index is greater than 30 kg per meter squared. A patient is considered to have a high likelihood of sleep disordered breathing if 2 or more categories are positive | at 16-24 weeks gestation and at 34 weeks gestation | 
| Perceived social support | Using the Multidimensional Scale of Perceived Social Support (MSPSS). MSPSS is a 12-item scale that measures the adequacy of social support. It consists of 3 subgroups that include items about family, friends and social support from a special person. It consists of 4 items for each group and each item is graded on a 7-item likert scale. A high total score indicates a high level of perceived social support. | 16-24 weeks gestation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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glucose range, neonatal outcomes, glycemic control, hypoglycemia, insulin resistance, preganant, pregnancy, CGM, Continuous Glucose Monitoring, Dexcom, maternal outcomes, Pregnancy in Diabetes