Covid-19 Gest-Testing study
Covid-19 has changed all our lives.
In pregnancy, standard methods of testing for diabetes in pregnancy have had to change because of social distancing requirements. We designed the Covid-19 Gest-Testing study to assess the performance of the new gestational diabetes diagnostic strategy.
Undiagnosed or untreated diabetes in pregnancy is associated with pregnancy complications, many of which can be prevented with accurate diagnosis and good treatment. However, standard testing for gestational diabetes, has not been possible in many sites as the oral glucose tolerance test (OGTT) cannot be performed during the Covid-19 pandemic. Interim recommendations for gestational diabetes diagnosis have been adopted internationally using random or fasting glucose with HbA1c. However, these criteria have not been extensively tested, and the adoption of new untested procedures is not risk-free. There is therefore an urgent need to identify better ways of identifying pregnancies at risk. The aim of this study is to evaluate the performance of these new criteria and to test a new approach using an OGTT at home, using continuous glucose monitoring (CGM).
We recruited 100 women, usually around 24-28 weeks of pregnancy, with risk factors for diabetes who have been invited for glucose testing in pregnancy. Women were asked to wear a CGM sensor for a week and give an extra blood sample at their standard clinical visit for glucose testing. Women were provided with a 75g glucose drink to be taken on day 3 at home after an overnight fast in order to trial a home OGTT.
CGM is used very widely now in people with type 1 diabetes and gives glucose results every 5 minutes via a small sensor placed on the skin. CGM is now very comfortable to wear and painless to insert. However, CGM has not yet been widely used in gestational diabetes. (See results of our CONCEPTT study for more information on using CGM in mums with type 1 diabetes and the benefits this has had for their babies).
The Covid-19 Gest-Testing Study was approved by the research ethics committee and health research authority (IRAS 282553; REC 20/ME/0133). The Covid-19 Gest-Testing Study was funded by Diabetes UK and is supported by free continuous glucose monitoring equipment from Dexcom Inc.
Study Progress: The GestTesting study is now closed to recruitment. We are currently analysing the data and writing up our results for publication. Thank you to the women who have taken part - much appreciated!
Initial results for the Covid-19 Gest-Testing have been really interesting and have been presented at:
ATTD conference, 2021.
Diabetes UK annual professional conference, 2021.
Diabetes in Pregnancy Study Group conference, 2021.
Diabetes in Pregnancy Study Group conference, due for Sept 2022.