Professor Fidelma Dunne (pictured above, left)
Personal Professor, School of Medicine, University of Galway, Consultant Physician in Endocrinology and Metabolism, Saolta University Healthcare Group, Director and PI, National Clinical Trial Network (CTN) Diabetes
A series of Irish-led studies are shedding light on how best to treat gestational diabetes, a condition in which diabetes develops during pregnancy.
Gestational diabetes (GDM), resulting in high blood sugar levels, requires close monitoring of mother and baby during pregnancy. Fidelma Dunne, Personal Professor in Medicine at University of Galway and Consultant Endocrinologist at Saolta University Health Care Group, has overseen dramatic changes in how hospitals diagnose and monitor the condition.
“In 2003, I was tasked with delivering diabetes in pregnancy services in Galway but could not find any up-to-date facts on either pregestational diabetes or GDM. So, with funding from the Health Research Board (HRB), we established the ATLANTIC – DIP network and set about generating up-to-date information along the Irish Atlantic seaboard by combining newly generated data from five hospitals providing antenatal clinical services,” she says.
Better way to treat gestational diabetes
Women with GDM who did not gain excessive weight had better pregnancy outcomes. Women who needed insulin struggled more with weight management. After reviewing the literature, Prof Dunne and her research team wondered if a long-established diabetes tablet could reduce complications and improve results for mothers with GDM and their babies.
This led to the EMERGE trial, the first placebo-controlled study of metformin for GDM. “Women who were assigned metformin had a 25% reduction in the need for insulin. They also had better glucose control and less weight gain. Additionally, their babies were less likely to be very big at birth,” she explains.
Women who were assigned metformin had
a 25% reduction in the need for insulin.
The study, presented at the American Diabetes Association meeting (June 2023), also found no increase in pre-term delivery, which was a concern raised in previous research. She adds: “The research and clinical community know that insulin availability for GDM is a problem in many low-income countries. If we could substitute metformin for insulin, this may have global benefits as metformin is cheap, readily available and easy to administer.”
Study leads to change in NICE guidelines
Prof Dunne’s team was also involved in the CONCEPTT TRIAL. It looked at whether continuous glucose-monitoring (CGM) technology in pregnancy helped women with type 1 diabetes gain better glucose control compared to usual finger-pricking devices and whether this technology led to fewer complications.
She explains: “The CONCEPTT trial showed that CGM provides better glucose control and reduces the likelihood of babies born with excessive weight. Use of CGM leads to better pregnancy outcomes and is also cost-effective. NICE guidelines now recommend that pregnant women with type 1 diabetes should be offered CGM. Continued investment in diabetes in pregnancy research will help to ensure that appropriate and timely screening, treatment and post-pregnancy follow-up are offered — improving health outcomes for mothers and babies.”