Sekhon Jasmin, Graham Dorothy, Mehrotra Chhaya, Li Ian
King Edward Memorial Hospital, Perth, Western Australia, Australia.
The University of Western Australia, Perth, Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2023 Apr;63(2):146-153. doi: 10.1111/ajo.13581. Epub 2022 Jul 14.
Women with type one diabetes experience poorer obstetric outcomes than normoglycaemic women in pregnancy.
To investigate the cost and clinical effectiveness of continuous glucose monitoring (GCM) compared to self-monitoring of blood glucose in improving obstetric outcomes in women with type one diabetes during pregnancy.
This retrospective cohort study included women with type one diabetes referred to a state-wide tertiary obstetric centre before and after the introduction of government-funded CGMs in Australia in March 2019. Forty-nine women using CGMs were propensity matched on a range of clinical features with a historical group of 49 women with type one diabetes who exclusively used intermittent self-monitoring of blood in the year prior to the introduction of funding of sensors. Medical records and administrative cost data were audited to quantify cost and clinical effectiveness.
There were significantly lower pre-term (95% CI 0.39-0.922; P = 0.026) and very pre-term birth rates (95% CI 1.002-1.184; P = 0.041) in the CGM group. There was a significant reduction in the length of antenatal inpatient hospital stay (P < 0.01) and adult special care unit stay (P = 0.013) and neonatal admission to the neonatal intensive care unit (P = 0.0262) in the continuous glucose monitoring group. CGMs represented a net cost saving to the health care sector of $12 063 per pregnancy where the device was used, with an incremental cost-effectiveness ratio of $3275 per prevented pre-term birth.
CGM use in pregnancy is a cost-effective intervention for reducing the risk of pre-term birth in women with type one diabetes, resulting in a net cost benefit to the health sector.
妊娠期间，1型糖尿病女性的产科结局比血糖正常的女性更差。
探讨与自我血糖监测相比，持续血糖监测（CGM）在改善1型糖尿病女性妊娠期间产科结局方面的成本和临床效果。
这项回顾性队列研究纳入了在2019年3月澳大利亚引入政府资助的CGM前后转诊至全州三级产科中心的1型糖尿病女性。49名使用CGM的女性在一系列临床特征上与一组历史对照的49名1型糖尿病女性进行倾向匹配，这组对照女性在传感器资助引入前一年仅使用间歇性自我血糖监测。审核病历和行政成本数据以量化成本和临床效果。
CGM组的早产（95%CI 0.39 - 0.922；P = 0.026）和极早产率（95%CI 1.002 - 1.184；P = 0.041）显著降低。持续血糖监测组的产前住院时间（P < 0.01）、成人特殊护理病房住院时间（P = 0.013）以及新生儿重症监护病房的新生儿入院率（P = 0.0262）均显著降低。在使用该设备的每次妊娠中，CGM为医疗保健部门节省了12,063美元的净成本，每预防一例早产的增量成本效益比为3275美元。
妊娠期间使用CGM是一种具有成本效益的干预措施，可降低1型糖尿病女性的早产风险，给卫生部门带来净成本效益。
