MON-568 - Prescribing Trends of Continuous Glucose Monitors in Pregnancies Complicated by Type 2 Diabetes and Associated Maternal and Neonatal Outcomes

INTRODUCTION
The use of continuous glucose monitoring (CGM) in pregnancy has expanded following recent regulatory approvals. However, while there are established benefits in type 1 diabetes, data supporting CGM use in pregnancies complicated by type 2 diabetes (T2DM) remain limited. Understanding CGM adoption and associated outcomes is critical to evaluating its role in this population.

To evaluate demographic and clinical factors associated with CGM use in pregnant individuals with T2DM and to compare maternal and neonatal outcomes between CGM and self-monitoring of blood glucose (SMBG).

METHODS
We conducted a retrospective cohort study using an existing database at a large community-academic health system, including births from January 2023 to July 2025. Pregnant individuals with pre-existing T2DM were identified and categorized by glucose monitoring modality: CGM or SMBG. Baseline demographics, glucose metrics, and maternal and neonatal outcomes were compared using Wilcoxon rank-sum tests for continuous variables and chi-square or Fisher’s exact tests for categorical variables, with significance defined as p< 0.05.

RESULTS
Among 283 patients included in the prescription cohort, those prescribed CGM were more likely to be white, English-speaking, not require an interpreter, receive care in urban settings, and they had a higher pre-pregnancy BMI. CGM prescription was also associated with endocrinology involvement and greater insulin use, including higher total daily insulin dose at birth.

In a subset of 207 patients with documented glucose monitoring data, 111 were monitored using SMBG and 96 using CGM. CGM use was strongly associated with endocrinology involvement (77.1% vs 33.3%, p< 0.001). CGM patients had more glucose data documented during pregnancy, and higher recorded fasting and postprandial glucose values than those using SMBG. At 28–30 weeks’ gestation, CGM patients had significantly higher average fasting and 1-hour postprandial glucose values, while SMBG patients had a significantly greater proportion of fasting values < 95 mg/dL and postprandial values within target range (all p< 0.01). Hemoglobin A1c 3 and 6 months prior to birth was lower in the CGM group than in the SMBG group, although interpretation is limited by differential data availability. There were no statistically significant differences in maternal or neonatal outcomes.

CONCLUSION
Patients differed along key demographics for use of CGMs. While those monitored with CGM had increased glucose data capture and higher recorded fasting and postprandial values, there was differences in perinatal outcomes. These may reflect differences in baseline disease severity, treatment intensity, and data capture rather than glycemic management alone, highlighting the need for prospective studies for standardized CGM implementation.

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