Intermittently scanned continuous glucose monitoring is associated with high satisfaction but increased HbA1c and weight in well‐controlled youth with type 1 diabetes

Abstract

Objective: We undertook a 24-month prospective observational single-center realworld trial to study impact of access to intermittently scanned continuous glucose monitoring (isCGM) on quality of life (QOL) and glycemic control of youth with type 1 diabetes (T1D). Methods: Between September 2016 and November 2017, 138 children and adolescents with T1D were recruited. Demographic, metabolic, and QOL data were collected during 24 months of routine follow-up. Primary endpoint was the evolution of QOL, with secondary outcomes change in HbA1c, occurrence of acute diabetes complications, and school absenteeism. Results: Ninety-two percent of participants found isCGM more user-friendly than capillary finger-stick tests and had high treatment satisfaction, without change in diabetes-specific QOL. HbA1c significantly increased from 7.2% (7.0-7.3) (55 mmol/ mol [53-56]) at baseline to 7.6% (7.4-7.8) (60 mmol/mol [57-62]) at 12 months (P < .0001) and was unchanged up to 24 months. Overall increase was mainly driven by children with baseline HbA1c <7.0% (<53 mmol/mol). Additionally, BMI adjusted for age was higher at study end. In year before isCGM, 228 days per 100 patientyears of school absenteeism were reported, which dramatically decreased to 13 days per 100 patient-years (P = .016) after 24 months. Parents of children also reported less work absenteeism (P = .011). Conclusion: The use of isCGM by T1D pediatrics is associated with high treatment satisfaction and fewer days of school absence. However, increased HbA1c and weight may reflect a looser lifestyle, with less attention to diet and more avoidance of hypoglycemia. Intensive education specifically focusing on these points may mitigate these issues.

Flash Glucose Monitoring Systems in Pediatric Populations With Diabetes

“…All 6 non-randomized studies [24][25][26][27][28][29] were prospective, single-centre, single-arm cohort studies. None of these non-randomized studies [24][25][26][27][28][29] included a control group; instead, these studies made comparisons from before to after switching from SMBG to FGM with the FreeStyle Libre. Study durations were 4 weeks, 26,28 12 weeks, 24,27 12 months, 29 and 24 months.…”

“…These comprised 3 health technology assessments [14][15][16] (that each included a systematic review with 14,15 or without 16 meta-analysis), 5 systematic reviews [17][18][19][20][21] (3 with meta-analysis 17,19,21 ), 2 publications 22,23 related to 1 randomized controlled trial (RCT), and 6 non-randomized studies. [24][25][26][27][28][29] Appendix 1 presents the PRISMA 30 flow chart of the study selection. Additional references of potential interest are provided in Appendix 5.…”

“…Three relevant health technology assessments (that each included a systematic review with 14,15 or without 16 meta-analysis), 5 systematic reviews [17][18][19][20][21] (3 with meta-analysis 17,19,21 ), 2 publications 22,23 related to 1 RCT, and 6 non-randomized studies [24][25][26][27][28][29] were identified for inclusion in this review. Detailed study characteristics are available in Appendix 2, Table 2 and Table 3.…”

“…The RCT was conducted in New Zealand. 22,23 Non-randomized studies were conducted in Belgium, 25 Saudi Arabia, 24,27 Singapore, 26 the UK, 29 and the United Arab Emirates. 28…”

“…The systematic reviews conducted as part of the EUnetHTA (2018) 14 and Health Technology Wales (2018) 16 29 included 52 children between the ages of 5 and 18 with type 1 diabetes. While some of these primary clinical studies [22][23][24][25][26][27][28][29] included participants above the age of 18, mean participant age was below 18 years in all cases; therefore, these studies were considered eligible.…”