Evaluation of Hemoglobin A1c before and after initiation of continuous glucose monitoring in children with type 1 diabetes mellitus

Abstract

Objectives The development of continuous glucose monitoring (CGM) systems has allowed for identification of blood sugar variations and trends in real-time that is not feasible with conventional self-monitoring of blood glucose. However, there is inconsistent data to show that the use of CGM leads to better glycemic control as measured by Hemoglobin A1c (HbA1c) in pediatric patients with type 1 diabetes mellitus. Our study aimed to compare the average HbA1c level in the 1–2 years prior to starting a CGM to the average HbA1c level in the 1–2 years immediately following CGM initiation in a sample of 1–20 year olds with type 1 diabetes mellitus. Methods Participants were 90 youth (ages 1–20) followed for type 1 diabetes care at our institution who used a CGM for at least a 6 month time period. We performed a retrospective chart review to obtain up to four HbA1c values pre and post-CGM initiation each. We evaluated pre- and post-CGM initiation changes in mean HbA1c via dependent samples t-tests using IBM SPSS 24.0. Results The mean HbA1c was 8.7% pre-CGM and decreased to 8.27% 9–12 months after CGM initiation in the overall sample. A statistically significant decrease in HbA1c was seen in patients who used multiple daily injections (p=0.02), those with a pre-CGM HbA1c greater than 9% (p=0.01), and those with a diabetes duration of 5–10 years (p=0.02). Conclusion CGM use was associated with a decrease in HbA1c over time which was statistically significant in some subgroups.

Effect of nationwide reimbursement of real-time continuous glucose monitoring on HbA1c, hypoglycemia and quality of life in a pediatric type 1 diabetes population: The RESCUE-pediatrics study

“…Data on SAP in a pediatric population studying the effect on HbA1c, hypoglycemia and/or QoL, are emerging (10,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(26)(27)(28). Eleven observational studies and five RCTs introducing RT-CGM in pediatric pump users, have been performed from 2010 until mid-2022, including 16 to 622 (of which 129 on SAP) children/adolescents with T1D per study, with a trial duration of 2 to 36 months.…”

“…Two RCTs compared (hybrid) closed-loop control to SAP ( 25 , 35 ). Main limitations of these studies are a rather short follow-up [only two studies with a follow-up longer than 12 months ( 23 , 28 )] and small study groups (nine studies with less than 50 patients).…”

“…Seven studies showed improvement in HbA1c with SAP from 0.3 to 0.7%, with baseline HbA1c ranging between 7.6 and 8.4% ( 10 , 14 – 16 , 19 , 23 , 24 ). Seven studies showed stable HbA1c values ( 17 , 18 , 25 – 28 , 35 ) or only improvement in patients with a poorer metabolic control at start (HbA1c > 7% of >7.5%) ( 21 , 22 ). The real-world study of Scaramuzza et al including 622 children with T1D with a follow-up of up to 36 months, compared SAP versus CSII ( 23 ).…”

“…This is accomplished by interrupting insulin delivery when glucose values reach or drop below a specified threshold [Low-Glucose Suspend (LGS) system] or even before hypoglycemia is reached (predictive LGS) (12). Eleven observational studies and five randomized controlled trials have been performed in children (10,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), demonstrating improvements in HbA1c (10, 14-16, 19, 23, 24), in hypoglycemia (16)(17)(18)(19)(20)25) and QoL (13,15,21,22,27), but data on the real-world impact of SAP in children for a period of more than 12 months are scarce (23).…”

The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps

“…The usage of CGM allows for continuous measurements instead of single point measurements. The definition of area under the curve (AUC) for glucose levels allows calculation of euglycemic time in target range (also called time in range (TIR)) [14]. This AUC/TIR via CGM is already complementing and will probably supersede HbA1c in the future in patients with CGM, as HbA1c only reflects glycemia over the previous 4 to 12 weeks and is unable to provide information on daily and postprandial glucose levels [15].…”