HYPO-CHEAT’s aggregated weekly visualisations of risk reduce real world hypoglycaemia

Worth, Chris; Nutter, Paul; Dunne, Mark J.; Salomon‐Estebanez, Maria; Banerjee, Indraneel; Harper, Simon

doi:10.1177/20552076221129712

Cited by 5 publications

(15 citation statements)

References 42 publications

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“…The potential to prevent hospital admissions and reduce length of stay, along with longer-term impact of reducing disability and the direct and indirect costs associated should be considered. Future studies incorporating artificial intelligence and machine learning algorithms may further reduce the burden of hypoglycaemia ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Accuracy and impact on quality of life of real-time continuous glucose monitoring in children with hyperinsulinaemic hypoglycaemia

Sivasubramanian,

Avari,

Gilbert

et al. 2023

Front. Endocrinol.

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ObjectiveContinuous glucose monitoring (CGM) is the standard of care for glucose monitoring in children with diabetes, however there are limited data reporting their use in hyperinsulinaemic hypoglycaemia (HH). Here, we evaluate CGM accuracy and its impact on quality of life in children with HH.MethodsReal-time CGM (Dexcom G5 and G6) was used in children with HH aged 0-16years. Data from self-monitoring capillary blood glucose (CBG) and CGM were collected over a period of up to 28days and analysed. Quality of life was assessed by the PedsQL4.0 general module and PedsQL2.0 family impact module, completed by children and their parents/carers before and after CGM insertion. Analysis of accuracy metrics included mean absolute relative difference (MARD) and proportion of CGM values within 15, 20, and 30% or 15, 20, and 30 mg/dL of reference glucose values >100 mg/dL or ≤100 mg/dL, respectively (% 15/15, % 20/20, % 30/30). Clinical reliability was assessed with Clarke error grid (CEG) analyses.ResultsProspective longitudinal study with data analysed from 40 children. The overall MARD between reference glucose and paired CGM values (n=4,928) was 13.0% (Dexcom G5 12.8%, Dexcom G6 13.1%). The proportion of readings meeting %15/15 and %20/20 were 77.3% and 86.4%, respectively, with CEG analysis demonstrating 97.4% of all values in zones A and B. Within the hypoglycaemia range (<70 mg/dL), the median ARD was 11.4% with a sensitivity and specificity of 64.2% and 91.3%, respectively. Overall PedsQL child report at baseline and endpoint were 57.6 (50.5 – 75.8) and 87.0 (82.9 – 91.2), and for parents were 60.3 (44.8 – 66.0) and 85.3 (83.7 – 91.3), respectively (both p<0.001).ConclusionUse of CGM for children with HH is feasible, with clinically acceptable accuracy, particularly in the hypoglycaemic range. Quality of life measures demonstrate significant improvement after CGM use. These data are important to explore use of CGM in disease indications, including neonatal and paediatric diabetes, cystic fibrosis and glycogen storage disorders.

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Section: Discussionmentioning

confidence: 99%

Accuracy and impact on quality of life of real-time continuous glucose monitoring in children with hyperinsulinaemic hypoglycaemia

Sivasubramanian,

Avari,

Gilbert

et al. 2023

Front. Endocrinol.

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“…Previously collected CGM data was used to identify periods of high hypoglycaemia risk in the early morning in patients with CHI; opening the door for targeted interventions on a group and individual level. Further work by this group ( 81 ) investigated patterns of hypoglycaemia at an individual level and found that each patient with CHI had clear and individual weekly patterns for repeated hypoglycaemia. Peeks et al.…”

Section: Novel Directions and A Possible Future For Cgm In Hypoglycaemiamentioning

confidence: 99%

“…Worth et al. used CGM to identify individual patterns in weekly hypoglycaemia risk of patients with CHI ( 81 ). The same group developed interpretative algorithms to facilitate patient understanding of patterns and provided suggestions for reflection designed to modify parental behaviours ( 35 ).…”

Section: Novel Directions and A Possible Future For Cgm In Hypoglycaemiamentioning

confidence: 99%

“…The same group developed interpretative algorithms to facilitate patient understanding of patterns and provided suggestions for reflection designed to modify parental behaviours ( 35 ). The resulting change in fingerprick and self-management behaviours led to a reduction in real world hypoglycaemia of 25% ( 35 , 81 ), demonstrating the potential power of using CGM as a tool to identify and modify the behavioural determinants of hypoglycaemia. Due to the focus on weekly patterns and behavioural determinants of hypoglycaemia, this approach is less subject to problems with poor point accuracy and patient dissatisfaction with alarms, suggesting a novel and sustainable path to CGM application.…”

Section: Novel Directions and A Possible Future For Cgm In Hypoglycaemiamentioning

confidence: 99%

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Continuous glucose monitoring for children with hypoglycaemia: Evidence in 2023

et al. 2023

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In 2023, childhood hypoglycaemia remains a major public health problem and significant risk factor for consequent adverse neurodevelopment. Irrespective of the underlying cause, key elements of clinical management include the detection, prediction and prevention of episodes of hypoglycaemia. These tasks are increasingly served by Continuous Glucose Monitoring (CGM) devices that measure subcutaneous glucose at near-continuous frequency. While the use of CGM in type 1 diabetes is well established, the evidence for widespread use in rare hypoglycaemia disorders is less than convincing. However, in the few years since our last review there have been multiple developments and increased user feedback, requiring a review of clinical application. Despite advances in device technology, point accuracy of CGM remains low for children with non-diabetes hypoglycaemia. Simple provision of CGM devices has not replicated the efficacy seen in those with diabetes and is yet to show benefit. Machine learning techniques for hypoglycaemia prevention have so far failed to demonstrate sufficient prediction accuracy for real world use even in those with diabetes. Furthermore, access to CGM globally is restricted by costs kept high by the commercially-driven speed of technical innovation. Nonetheless, the ability of CGM to digitally phenotype disease groups has led to a better understanding of natural history of disease, facilitated diagnoses and informed changes in clinical management. Large CGM datasets have prompted re-evaluation of hypoglycaemia incidence and facilitated improved trial design. Importantly, an individualised approach and focus on the behavioural determinants of hypoglycaemia has led to real world reduction in hypoglycaemia. In this state of the art review, we critically analyse the updated evidence for use of CGM in non-diabetic childhood hypoglycaemia disorders since 2020 and provide suggestions for qualified use.

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“…Worth et al reported that short-term use of an algorithm to detect weekly patterns in hypoglycemia frequency resulted in reduced time below range (hypoglycemia) from 7.1-5.4% [26]. However, in a related study, this same group found that CGM alone had insufficient accuracy for use as a standalone tool in clinical practice.…”

Section: Managementmentioning

confidence: 99%

Bridging the gaps: recent advances in diagnosis, care, and outcomes in congenital hyperinsulinism

Rosenfeld

León

2023

Current Opinion in Pediatrics

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Purpose of review To highlight advances in congenital hyperinsulinism (HI), including newly described molecular mechanisms of disease, novel therapeutic interventions, and improved understanding of long-term outcomes. Recent findings Important advances have been made elucidating the molecular mechanisms responsible for HI. Non-coding variants in HK1 have been found to cause aberrant hexokinase expression. Inactivating mutations in SLC25A36 have been identified in children with features of the hyperinsulinism hyperammonemia syndrome. Low-level mosaic mutations in known HI genes have been detected in cases of ‘genetic testing negative’ HI. Identification and localization of focal HI lesions remains a priority, since focal HI can be cured with surgery. Use of 68Ga-NODAGA-exendin-4 PET has been proposed to localize focal lesions. Additional studies are needed before this technique replaces 18F-DOPA PET as standard of care. Treatment options for children with diffuse HI remain limited. The long-acting somatostatin analog, lanreotide, was shown to significantly improve glycemic control in a large series of children with HI. New therapies are under development, with promising preliminary results. Long-term quality of life and neurodevelopmental outcomes remain suboptimal. Summary Advanced genetic and epigenomic analytic techniques have uncovered novel molecular mechanisms of HI. Development of new drugs holds promise to improve long-term outcomes for individuals with HI.

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HYPO-CHEAT’s aggregated weekly visualisations of risk reduce real world hypoglycaemia

Cited by 5 publications

References 42 publications

Accuracy and impact on quality of life of real-time continuous glucose monitoring in children with hyperinsulinaemic hypoglycaemia

Accuracy and impact on quality of life of real-time continuous glucose monitoring in children with hyperinsulinaemic hypoglycaemia

Continuous glucose monitoring for children with hypoglycaemia: Evidence in 2023

Bridging the gaps: recent advances in diagnosis, care, and outcomes in congenital hyperinsulinism

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