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RESEARCH: Helen R Murphy, Gerry Rayman, Karen Lewis, Susan Kelly, Balroop Johal, Katherine Duffield, Duncan Fowler, Peter J Campbell, and Rosemary C Temple Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial BMJ 2008; 337: a1680 [Abstract] [Full text]

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Costs of Glucose Continuous Monitoring in Pregnant Women with Diabetes

Dario Iafusco, Fabrizio Stoppoloni, Gennaro Salvia, Gilberto Vernetti, Goran Petrovski and Francesco Prisco   (28 September 2008)

Costs of Glucose Continuous Monitoring in Pregnant Women with Diabetes 28 September 2008
Dario Iafusco, MD Researcher Department of Pediatrics - Second University of Naples - via L. De Crecchio,4 - 80138 Naples Italy, Fabrizio Stoppoloni, Gennaro Salvia, Gilberto Vernetti, Goran Petrovski and Francesco Prisco Send response to journal: Re: Costs of Glucose Continuous Monitoring in Pregnant Women with Diabetes	The Article of Murphy AR et(1) cited by the Editorial of Festin MR (2) al brings up two important points to evaluate the effectiveness of continuous glucose monitoring during pregnancy in women with diabetes: the improved glycaemic control in the third trimester and the prevention of infant macrosomia. They do also an approximate benefit-cost ratio and the cost of glucose sensors was £160 per pregnancy (excluding equipment). In our opinion, two topical moments in the pregnancy of type 1 diabetes patients when continuous glucose monitoring is very useful to obtain the well being of the fetus are during administration of betamethasone to prevent respiratory distress of newborn and at the moment and in the first hours after labour to prevent maternal hyperglycaemia and infant hypoglycaemia. Recently we have published a short report about this subject (3) and we have showed that the continuous intravenous infusion of insulin (from 0.02 U/Kg/h to 0.06 U/Kg/h), guided by glucose levels, enabled us to reach and maintain glucose levels constant between 100 and 150 mg/dl during treatment with betamethasone and during labour up to delivery in the vaginal delivery and between 80 and 100 mg/dl during caesarean section birth. During delivery is a period of high risk for babies from type 1 diabetic mothers when hyperglycaemia could induce the newborns to produce high amounts of insulin with the consequence of hypoglycaemic status after cutting the blood cord. We think that in these two topical moments continuous glucose monitoring may be used with all pregnant diabetic mothers independently of ethnicity or cultures because it is applied during hospitalisation. If we consider the Murphy AR et (1) and our (3) articles the total cost of glucose sensors may be £240 per pregnancy. References 1) Murphy HR, Rayman G, Lewis K, Kelly S, Johal B, Duffield K, Fowler B, Campbell PJ, Temple RC Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial BMJ 2008;337:a1680 2) Festin MR Continuous glucose monitoring in women with diabetes during pregnancy BMJ 2008;337:a1472 3) Iafusco D, Stoppoloni F, Salvia G, Vernetti G, Passaro P, Petrovski G and Prisco F Use of real time continuous glucose monitoring and intravenous insulin in type 1 diabetic mothers to prevent respiratory distress and hypoglycaemia in infants. BMC Pregnancy and Childbirth 2008, 8: 23 Corresponding Author: Dario Iafusco MD, Department of Pediatrics, Second University of Naples, Via S. Andrea delle Dame, 4 80139 Naples, Italy E.mail: dario.iafusco@unina2.it Competing interests: None declared