Intelligent diabetes care designed for pregnancy

Easily connect state-of-the-art diabetes management into your obstetrics practice.

"LilyLink is changing the game by empowering OBGYNS and their patients with synchronous, easily-digestible data to drive better care and improve outcomes."

Audrey Merriam
MD, OBGYN, Maternal-Fetal Medicine
Created with expert advisors from

1 in 7 pregnancies are complicated by diabetes.

Diabetes increases risks and is time-intensive to manage for both patients and providers.

Pregnant women have been an afterthought for diabetes tech companies

Gestational diabetes is different from other types — there is no one-size-fits-all approach.

LilyLink is closing the gap

Equip your OB clinic with the first billable, tech-enabled diabetes program built specifically for high-risk prenatal care.

Improve patient experience and outcomes
Streamline diabetes management work and reduce staff burnout
Track and claim remote monitoring activities

An end-to-end platform developed by a team of OBGYN, MFM, and RD providers

Automate postprandial logging with patient mobile app
View data summaries directly from an EHR-integrated portal
Easily implement CGMs as part of standard of care
Increase reimbursements with remote monitoring tools
Leverage a virtual team for diabetes training and nutrition counseling

An end-to-end platform developed by and for clinical providers.

Automate postprandial logging with patient mobile app

A simple, intuitive app with one-tap meal entry, weekly glucose summaries, and apple health integration.

View data summaries from an EHR-integrated portal

Aggregate patient data and access quick summaries to help streamline patient care and stratify risk.

Easily implement CGMs as part of standard of care

Our platform transforms raw continuous glucose monitoring (CGM) data into actionable postprandial logs recommended by the latest clinical guidelines.

Increase reimbursements with remote monitoring tools

Track RPM activities and increase reimbursements through new billings

A virtual team for diabetes training & nutrition counseling

Our GDM-trained dieticians and certified diabetes educators serve as an extension of your clinic staff

Compatible with leading glucose monitoring devices
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Featured

November 25, 2024

Can Continuous Glucose Monitors (CGMs) Be Used for Gestational Diabetes?

Use of continuous glucose monitoring (CGM) for gestational diabetes seems to be lagging behind the rest of the diabetes community. Pregnant patients are often the last to be included in research, and it can be difficult to shift practice protocols to accommodate new technology. Although CGM use has been proven to improve the quality of life in a person with diabetes (PWD), they are not regularly prescribed to patients with gestational diabetes.1 

It’s cumbersome for pregnant patients to keep a detailed blood sugar log. Nobody likes to do fingersticks. Readings get missed. Meals aren’t tracked. Paper logs get lost. And it’s a challenge for the obstetrics practice. It requires staff time to review the glucose logs and you are forced to make treatment decisions based on spotty data and rough meal estimates. 

CGMs could revolutionize gestational diabetes care. Between real-time feedback on treatment and meal impact and the ability to review overnight glucose levels—without sleep disruption, CGMs are a vital tool for managing diabetes. But can you use CGMs for gestational diabetes? Are they accurate? Keep reading to see how CGMs can be a valuable tool for women with gestational diabetes.

TL;DR: The latest CGMs from Dexcom and Abbott (Freestyle Libre) are proven accurate in pregnancy and a trusted method of monitoring glucose levels in gestational diabetes. Insurance coverage for CGM is also improving. However, CGMs require additional apps and tools to conform with ACOG guidelines.

CGM Use in Gestational Diabetes

CGM use in gestational diabetes

CGMs capture real-time glucose data around the clock. This regular access to glucose trends allows for diet and insulin doses to be modified to reduce the incidence of both hyperglycemia and hypoglycemia. Not to mention that depending on the CGM system, there are fewer fingersticks, if any. But are CGMs accurate?

Are CGMs Accurate in Pregnancy?

Of course, accuracy of CGMs is a valid concern. Fortunately, recent clinical trials around CGM use in pregnancy have shown them to be accurate. But first, let’s address CGM’s accuracy overall. The mean absolute relative difference (MARD) is how the accuracy of CGM systems is measured. A lower number suggests greater accuracy, and a MARD <10% is considered acceptable.2 

Here are the MARD values for the most commonly used CGMs in gestational diabetes:

  • Dexcom G7: 8.2%
  • Freestyle Libre 2: 9.2%
  • Freestyle Libre 3: 7.9%

When researchers compared real-time CGM (rtCGM) readings with samplings of venous blood at ~15 (+/- 5) minute intervals over a 6 hour period of time, over 83% of the CGM values were within 15% of the venous values.3

While their findings revealed the MARD was a bit higher on the first day of wear, the overall MARD was 9.5%—still within the acceptable range.

Intermittently scanned CGM (isCGM) is also accurate during pregnancy. Comparisons were made with pairs of fingerstick glucose levels and isCGM and were found to be clinically consistent.4 The difference between the two was about 16%, with the isCGM trending a bit lower in values. All are considered safe and accurate, which is why they have achieved approval.

Are CGMs Approved for Use in Gestational Diabetes?

Yes, CGMs are approved for use in GDM. CGM manufacturers must go through a systematic process to obtain Federal Drug Administration (FDA) approval for use in pregnancy.

First, preclinical studies are performed to evaluate the accuracy and safety of use. Additionally, clinical trials are conducted with pregnant women with gestational diabetes to assess performance and efficacy. Abbott and Dexcom have completed the process and received specific clearance for use in gestational diabetes. Currently approved CGMs include:

While insurance coverage of CGMs for patients with GDM varies, many payors are starting to cover CGM. For example, California Medi-Cal now covers CGM for gestational diabetes and up to one year postpartum. Both FreeStyle and Dexcom have patient assistance programs to help lower costs in cases where insurance will not cover them.

So CGMs are approved and covered for GDM patients, but are the apps useful in pregnancy?

Do the CGM Apps Conform to ACOG Guidelines for Pregnancy?

Unfortunately, shortcomings in the design of CGM apps are an aspect of CGMs that limit their use in pregnancy.

One major difference between the data needs of diabetes in pregnancy and the non-pregnant population is the change in the target range. Most CGM apps and data outputs are reported according to the non-pregnant population (70-180 mg/dL as the target range). However, we know from the American College of Obstetrics and Gynecology (ACOG) that glucose targets are lower in pregnancy — 63-140 mg/dL. Settings are not easily adjusted to pregnancy-specific goals, and your patient’s CGM app may be showing them that they are in the “green”, when they are at a less desirable level for pregnancy.

Another key difference is that most OBGYNs and perinatologists prescribe therapy based on fasting and postprandial blood sugar values (with fasting target under 95 mg/dl and postprandial under 140 mg/dL for 1hr or 120 mg/dL for 2hr).  While CGM apps may let you note meal times, they do not automatically calculate fasting and postprandial values, or arrange them into daily logs that providers typically use.  

To make CGMs work well for gestational diabetes, pregnancy-specific digital health tools can help connect the dots.

LilyLink Provides Pregnancy-Specific Data

The founders of LilyLink saw how diabetes tech was not tailored for gestational diabetes care. In response, they designed the LilyLink platform under guidance from Maternal-Fetal Medicine (MFM) specialists to conform to diabetes management recommendations for pregnancy. 

The app is compatible with all pregnancy-approved CGMs, and users will see how their numbers stack up to the ACOG and American Diabetes Association (ADA) guidelines. Postprandial logging is automated and users can take pictures of their meals and enter exercise to play an active role in their GDM care. The provider then has direct access to CGM-generated digital logs and summary reports.

Example of a CGM-generated digital postprandial log

Example of a CGM-generated digital postprandial log

CGMs can be used for GDM and their use can better conform to ACOG guidelines with LilyLink’s end-to-end solution. The technology offers a promising tool for those managing GDM to improve maternal and fetal outcomes.

Easily Incorporate CGMS into Your Obstetrics Practice

CGM use in gestational diabetes has great potential to improve maternal and fetal outcomes, optimize glucose management, and enhance user acceptability in those with GDM. So far, what we know:

  • CGMs are indeed accurate in pregnancy and can be a trusted method of monitoring glucose levels in gestational diabetes.
  • Several CGMs have been indicated for use in GDM: Dexcom G7, FreeStyle Libre 2, and FreeStyle Libre 3.
  • The CGM apps do not report data using the targets recommended by ACOG and ADA.
  • The LilyLink app is designed for use in pregnancy and is optimized considering the data needs for this specific population.

Looking to incorporate CGMs into your OB practice? LilyLink can simplify the process with our end-end diabetes platform designed specifically for high-risk pregnancy care. Schedule a demo today.

References

  1. Johnston AR, Poll JB, Hays EM, Jones CW. Perceived impact of continuous glucose monitor use on quality of life and self-care for patients with type 2 diabetes. Diabetes Epidemiology and Management. 2022;6:100068. doi:10.1016/j.deman.2022.100068.
  2. Heinemann L, Schoemaker M, Schmelzeisen-Redecker G, et al. Benefits and Limitations of MARD as a Performance Parameter for Continuous Glucose Monitoring in the Interstitial Space. J Diabetes Sci Technol. 2020;14(1):135-150. doi:10.1177/1932296819855670
  3. Polsky S, Valent AM, Isganaitis E, et al. Performance of the Dexcom G7 Continuous Glucose Monitoring System in Pregnant Women with Diabetes. Diabetes Technol Ther. 2024;26(5):307-312. doi:10.1089/dia.2023.0516
  4. Hussain FN, Raymond S, Feldman KM, et al. Comparison of an Intermittently Scanned (Flash) Continuous Glucose Monitoring System to Standard Self-Monitoring of Capillary Blood Glucose in Gestational Diabetes Mellitus. Am J Perinatol. 2023;40(11):1149-1157. doi:10.1055/a-2053-7650

Hear what practitioners and patients are saying

"LilyLink's CGM integration is uniquely designed to support diabetes during pregnancy — I’m excited about enhancing my own care through improved data collection and data-driven insights."

Jill Garnier
MD, OBGYN, FACOG

“LilyLink takes diabetes management during pregnancy to the next level for providers and patients. Being able to gather and interpret data in one place, and be reimbursed for it, will improve the way we provide care!”

Christina Inteso
PharmD, CDCES

"Managing gestational diabetes can be overwhelming for patients. LilyLink streamlines the process, offering valuable feedback and support which empowers patients to manage their condition more effectively."

Erin Davis
RD, CDCES

"It gives me peace of mind knowing that the data is automatically transferred and synced, which means there aren’t gaps when patients weren’t able to update their log"

Hebron Kelecha
MD, MPH

I love this app! It’s so much easier, I don’t have to step out of meetings to check blood sugars anymore. I just take a picture when I eat and the data that comes out is exactly what my OB wants.”

Erin Sweeney
GDM patient