The role of continuous glucose monitoring in the care of children with type 1 diabetes

Abstract

Continuous glucose monitoring (CGM), while a relatively new technology, has the potential to transform care for children with type 1 diabetes. Some, but not all studies, have shown that CGM can significantly improve hemoglobin A1c levels and reduce time spent in the hypoglycemic range in children, particularly when used as part of sensor-augmented pump (SAP) therapy. Despite the publication of recent clinical practice guidelines suggesting CGM be offered to all children 8 years of age or older who are likely to benefit, and studies showing that younger children can also benefit, this technology is not yet commonly used by children with type 1 diabetes. Effects of CGM are enhanced when used on a near-daily basis (a use-dependent effect) and with insulin pump therapy. Therefore, coordinated strategies are needed to help children and their families initiate and continue to use this resource for diabetes care. This review introduces CGM to pediatric endocrinologists who are not yet familiar with the finer details of this technology, summarizes current data showing the benefits and limitations of CGM use in children, reviews specific case examples demonstrating when CGM can be helpful, and shows the value of both retrospective and real-time CGM. It is hoped that this information leads to discussion of this technology in pediatric endocrinology clinics as an important next step in improving the care of children with type 1 diabetes.

A pilot study of continuous glucose monitoring in critically ill patients: Do they perform well enough for use in glycaemic control?

“…Conversely, the iPro2 is calibrated retrospectively, so one would expect the same disturbances to have less impact on the overall accuracy, as future calibration BG values are known. Overall, the MARD values presented here are all in the region of reported MARD for CGM in outpatients, where the devices were designed to be used (Kovatchev et al, 2008, Larson andPinsker, 2013), indicating that they otherwise performed as might be expected despite the different cohort.…”

Subcutaneous Insulin Pump

“…Among children there was an absolute reduction in HbA 1c of 0.4 ± 0.9% in the SAP therapy group and an increase of 0.2 ± 1.0% in the MDI group. Several other RCTs have confirmed that SAPs improve glucose control at no increased risk of hypoglycemia in pediatric patients [19][20][21]. Therefore, age does not seem to be a factor for the success of SAP therapy.…”

“…At entry, 90 patients in each group had a normal albumin excretion rate and 20 had persistent microalbuminuria. The albumin excretion rate [median (95% CI)] was similar at baseline [6.0 μg/min (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) in the CSII group vs. 4.4 (8)(9)(10)(11)(12)(13)(14)(15)(16) in the MDI group, NS] and significantly lower in the patients treated with CSII, both at year 2 and at year 3 of follow-up [4.7 μg/min (6-12) vs. 6.4 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), p < 0.002]. Nine patients progressed to microalbuminuria in the MDI group while only 1 did in the CSII group.…”

Experiences in Sensor-Augmented Pump Therapy in Families with two Children with Type 1 diabetes: A Qualitative Study

“…In spite of being the most advanced technology, CGM and SAP are still rarely used in routine care of children and adolescents with type 1 diabetes mellitus (Type 1 DM) [4,5].…”