Continuous Glucose Monitoring in Glucokinase-maturity-onset Diabetes of the Young Pregnancy: A Treatment Paradigm Change

Abstract

Management of hyperglycemia in glucokinase-maturity-onset diabetes of the young (GCK-MODY) pregnancies is dependent on whether the fetus inherits the mutant GCK allele. Current recommendations include frequent ultrasounds in the third trimester to detect excessive fetal growth, which points toward an unaffected fetus who is at risk of macrosomia and could benefit from treatment with insulin. We present a case of continuous glucose monitoring (CGM) use in GCK-MODY pregnancy, in whom insulin treatment was initiated early. We discuss the CGM-glucometrics that associate with pregestational diabetes and how these could apply in the setting of GCK-MODY pregnancies to guide the need for insulin treatment when the fetal genotype is unknown. There remains a need to establish CGM thresholds for insulin initiation and glycemic targets in GCK-MODY pregnancies.