SUN-544 - Real-Time Continuous Glucose Monitoring in GDM: Perceptions of Behavior Modification, Lifestyle, and Self-Care Changes

Background
Gestational diabetes mellitus (GDM) is increasingly common and linked to adverse pregnancy outcomes. Real-time continuous glucose monitoring (RT-CGM) may improve lifestyle and outcomes, yet data for GDM are limited. This study aimed to assess RT-CGM's impact on lifestyle in GDM patients.
Methods
An open-label randomized controlled trial assigned women with GDM to either RT-CGM or blinded CGM plus self-monitoring. Participants completed a lifestyle survey, food questionnaire, activity questionnaire, Problem areas in diabetes (PAID), and World Health Well Being Index(WHO). No obstetric provider contact occurred during the study.
Results
105 women enrolled: 53 with RT-CGM, 52 with blinded CGM; high withdrawal from the SMBG group was primarily due to demand for RT-CGM. Participants started CGM at an average gestational age of 29.8 weeks wearing it for 64 days(SD19.4). We previously reported glycemic indices and no significant differences were found in glycemic indices, though satisfaction was high. Among RT-CGM users, most reported limiting rice (80%), sugared drinks (69.5%), and cereal (63%). 60% checked labels for fiber and 80% reduced or limited foods after CGM use. Increased activity was noted by 60.9%, with 82% reporting being more likely to walk after meals if saw rising glucose. 63% felt OB visits were easier and 91% felt RT-CGM supported a healthier lifestyle. Composite food scores did not differ significantly. The intervention group was less active at baseline, with only 23.8% (10/42) walking 5-7 days per week compared to 50% (9/18) in the control group. After 3 months, 33% (14/42) of the intervention group and 50% (9/18) of the control group were walking 5-7 days per week. WHO assessment showed no statistically significant differences. PAID scores were similar at baseline. After 3 months, control group scores were 6.9 (SD 4.2) and intervention group scores were 8.9 (SD 4.9), p = .11. Mean change was -3.2 (SD 3.7) for controls and -0.7 (SD 3.7) for the intervention, p = .01. With the CGM stratification questions 19/46 responded (41.3%) that it made them less worried about controlling glucose but 17/46 felt it made them more worried (36%).
Conclusion
RT-CGM was well-received among GDM patients and appears to promote nutrition, physical activity, and self-care but does not decrease distress. More objective measurements and further research are needed to be define how RT-CGM supports lifestyle modification in pregnancy.

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