Continuous Subcutaneous Glucose Monitoring in  Children With Type 1 Diabetes

Zung, Amnon; Zadik, Zvi

doi:10.1542/peds.107.2.222

Cited by 186 publications

(137 citation statements)

References 11 publications

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“…Table 1 summarises characteristics of the included trials. Five RCTs involving 131 participants met our predefined inclusion criteria [15][16][17][18][19]; the remaining 20 studies were excluded [7,[11][12][13][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Table 2 summarises the characteristics of excluded trials, including reasons for exclusion.…”

Section: Resultsmentioning

confidence: 99%

“…All included trials were small, one-centre studies; two of them were performed in Europe [15,16], two in the USA [17,19] and one in Australia [18]. Three of the included trials [17][18][19] had parallel-group design and two others [15,16] were crossover.…”

Section: Resultsmentioning

confidence: 99%

“…Three of the included trials [17][18][19] had parallel-group design and two others [15,16] were crossover. There was considerable clinical heterogeneity among the trials with regard to the children's age, diabetes duration, frequency of CGMS use and insulin adjustments.…”

Section: Resultsmentioning

confidence: 99%

“…Depending on the trial, patients had to wear CGMS: every 5 days [17], every 2 weeks [16], every 3 weeks [18], every 2 months [19] or once during a 3 month period [15]. We also found significant differences in the frequency of insulin changes: >11 times during 1 month (experimental group only) [17], every 3 weeks [18], every 6 weeks [16] and every 2 months [19]. Follow-up periods extended up to 3 months in three trials [15][16][17] and up to 6 months in the other two trials [18,19].…”

Section: Resultsmentioning

confidence: 99%

“…Meta-analysis of continuous data using mean difference demanded extraction of the following: the mean values of the outcomes, the standard deviations of the outcomes and the number of participants in both groups for whom the outcome was assessed. In one study [17], data concerning the effect of treatment on HbA 1c were calculated on the basis of individual patient results, presented in the article in form of a table. Yet, these values differed from the summarised results presented by the authors.…”

Section: Methodsmentioning

confidence: 99%

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Continuous Glucose Monitoring System in children with type 1 diabetes mellitus: a systematic review and meta-analysis

et al. 2007

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Aims/hypothesis We investigated the potential effects of the Continuous Glucose Monitoring System (CGMS), as compared with self-monitoring of blood glucose, on glycaemic control in children with type 1 diabetes. Methods The following electronic databases were searched throughout June 2007: MEDLINE, EMBASE and The Cochrane Library. Additional references were obtained from reviewed articles. Only randomised controlled trials were included. Results We included five trials involving 131 type 1 diabetic patients in the study. Combined data from all trials showed that the CGMS did not significantly reduce HbA 1c levels compared with control groups. The pooled weighted mean difference was −0.02% (95% CI −0.29 to 0.25) with a fixed model and remained insignificant in the random effect model. Sensitivity analysis determined that the findings were stable. There was a trend towards a longer time under the CGMS curve for glucose <3.89 mmol/l in the CGMS group compared with the control group (mean difference 49.00 min, 95% CI −18.00 to 116.00). The CGMS significantly increased the number of insulin dose changes per patient per month for those managed with CGMS compared with the control groups (mean difference 6.3 changes, 95% CI 2.88-9.72). Conclusions/interpretation The Continuous Glucose Monitoring System is not better than self-monitoring of blood glucose with regard to improvement of metabolic control among type 1 diabetic children. However, due to the small number of participants and methodological limitations of the studies included, findings of this meta-analysis should be interpreted with caution.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Continuous Glucose Monitoring System in children with type 1 diabetes mellitus: a systematic review and meta-analysis

et al. 2007

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Glycemic Patterns Detected by Continuous Subcutaneous Glucose Sensing in Children and Adolescents With Type 1 Diabetes Mellitus Treated by Multiple Daily Injections vs Continuous Subcutaneous Insulin Infusion

Weintrob

Schechter²,

Benzaquen³

et al. 2004

Arch Pediatr Adolesc Med

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Objective: To compare glycemic patterns by mode of therapy in children with type 1 diabetes mellitus using the Continuous Glucose Monitoring System (CGMS).Design: Open randomized crossover comparing 3 1 ⁄2 months of multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII).Setting: Tertiary care, university-affiliated medical center.Patients: Twenty-three children and adolescents with type 1 diabetes mellitus. Interventions:The CGMS was applied for 72 hours after 1 month and at the end of each study arm. Main Outcome Measures:Hemoglobin A 1c levels and glucose level profiles were compared between the 2 study arms and the 2 sensor applications for each arm.Results: The arms were similar for mean (SD) hemoglobin A 1c levels (CSII, 8.0% [0.8%]; and MDI, 8.2% [0.8%]) and glucose levels. Areas under the curve were significantly larger during MDI for nocturnal and 24-hour hypoglycemia (P=.01 and .04, respectively) and for postprandial hypoglycemia and hyperglycemia (P=.03 and .05, respectively). The rate of hyperglycemia increased during CSII (P =.03), but 24-hour duration and area under the curve for hyperglycemia were similar. Compared with the first CGMS reading in each arm, the second had a longer mean duration of postprandial withintarget glucose levels (P=.04), tendency for lower rate of diurnal hypoglycemic events (P=.1), shorter duration of nocturnal hypoglycemia (P=.05), and smaller 24-hour area under the curve for hypoglycemia (P =.04). Conclusions:Intensive treatment with CSII seemed to be associated with slightly better prebreakfast, postprandial, and within-target glucose profiles than MDI, as well as a smaller area under the curve for hypoglycemia. Lower hypoglycemia-related variables in the second sensor reading in each arm indicate that the CGMS may serve as an educational tool to decrease the rate and magnitude of hypoglycemia.

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Participatory Surveillance of Hypoglycemia and Harms in an Online Social Network

Weitzman¹,

Kelemen²,

Quinn³

et al. 2013

JAMA Intern Med

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Surveillance systems for elucidating the burden of hypoglycemia are limited.Objective: To quantify experiences of hypoglycemia and related harms, members of an international online diabetes social network with insulin-dependent diabetes mellitus were polled through a software application ("app"). Aggregate results were returned to participants through network channels. Design:The study period was from March 2011 through April 2012, during which time retrospective reports about experiences with hypoglycemia and related harms were collected from participants using the app. Setting:The study was undertaken within the TuDiabetes.org international online diabetes social network.Participants: Eligibility criteria included TuDiabetes membership, age 13 years or older, a self-reported diagnosis of diabetes mellitus, ability to read and write English, and Internet access. Of 2827 app users, 687 (response rate, 24.3%) opted in to the volunteer sample.Main Outcome Measures: Primary outcomes included the following: frequency of "going low" (having a low glucose value in the past 2 weeks) and episodes of severe hypoglycemia (in the past 12 months), and, for respondents reporting recent and/or severe hypoglycemia, lifetime experience of vehicle crashes or severe medical injury, daily debilitating worry, and withdrawal from driving, exercise, sex, and going outside of the home to avoid hypoglycemia and consequences. Secondary outcomes included measures of research engagement.Results: Of 613 respondents (24.3% of app users), 49.1% reported more than 4 episodes of "going low" in the past 2 weeks and 29.2% reported 1 or more severe low in the past year; 16.6% reported both more than 4 recent low episodes and 1 or more severe event in the past year. Harms were common, including daily debilitating worry (45.8%), vehicle crash or injury (15.0%), and withdrawal from exercise, driving, leaving home, and having sex (54.0%, 37.4%, 24.8%, and 22.7%, respectively). Of all respondents, 54.2% reported multiple harms, the risks for which were highest (73.7%) among respondents with a past-year severe event (odds ratio, 2.39; 95% CI, 1.60-3.58; PϽ.001 controlling for frequent recent low episodes and demographic and disease factors). Engagement was high, with 96.6% of the sample permitting recontact for research and 31.7% posting personal study data on their app profile page; 40.5% of 2825 unique page views of research-related materials published on the community site involved views of returned research results.Conclusions and Relevance: Participatory surveillance of hypoglycemia in an online diabetes social network enables characterization of patient-centered harms in a community sample and bidirectional communication with affected persons, augmenting traditional surveillance.

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Continuous Subcutaneous Glucose Monitoring in Children With Type 1 Diabetes

Abstract: In this pilot trial, continuous subcutaneous glucose monitoring was helpful in detecting asymptomatic nocturnal hypoglycemia as well as in lowering HbA1c values without increasing the risk for severe hypoglycemia in children with type 1 diabetes.

Cited by 186 publications

References 11 publications

Continuous Glucose Monitoring System in children with type 1 diabetes mellitus: a systematic review and meta-analysis

Continuous Glucose Monitoring System in children with type 1 diabetes mellitus: a systematic review and meta-analysis

Glycemic Patterns Detected by Continuous Subcutaneous Glucose Sensing in Children and Adolescents With Type 1 Diabetes Mellitus Treated by Multiple Daily Injections vs Continuous Subcutaneous Insulin Infusion

Participatory Surveillance of Hypoglycemia and Harms in an Online Social Network

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