Time spent outside of target glucose range for young children with type 1 diabetes: a continuous glucose monitor study

DiMeglio, Linda A.; Kanapka, Lauren G.; DeSalvo, Daniel J.; Anderson, Barbara J.; Harrington, Kara R.; Hilliard, Marisa E.; Laffel, Lori M.; Tamborlane, William V.; Name, Michelle A. Van; Wadwa, R. Paul; Willi, Steven M.; Woerner, Stéphanie; Wong, Jenise C.; Miller, Kellee M.

doi:10.1111/dme.14276

Cited by 17 publications

(31 citation statements)

References 29 publications

(29 reference statements)

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“…In a recent multicenter study from USA (published in 2020) on 143 children aged 2–8 years with T1D, diMeglio et al report that children with MDI or pump treatment, with access to SMBG but without CGM, spend 40% of the time within a broader range, 3.9–10 mmol/L (70–180 mg/dl), and 4.1% below target. The DiMeglio cohort had a mean HbA1c of 66 mmol/mol (8.2%), 19 representing a significantly higher risk of complications than our 2008 cohort, which at that time had access to treatment technology comparable with the DiMeglio cohort.…”

Section: Discussionmentioning

confidence: 81%

“…Early childhood is a window of opportunity for the establishment of habits that have a high probability of following the child throughout itslife 17 . In particular, concerns regarding high glucose variability and a high frequency of undetected hypoglycemia episodes have been expressed 18,19 . Our hypothesis is that treatment outcomes have improved over the past decade in preschool children in parallel with the increased usage of CGM and insulin pumps.…”

Section: Introductionmentioning

confidence: 99%

“…17 In particular, concerns regarding high glucose variability and a high frequency of undetected hypoglycemia episodes have been expressed. 18,19 Our hypothesis is that treatment outcomes have improved over the past decade in preschool children in parallel with the increased usage of CGM and insulin pumps.…”

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confidence: 99%

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A decade of improved glycemic control in young children with type 1 diabetes: A population‐based cohort study

et al. 2021

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Background: Early-onset type 1 diabetes (T1D) is associated with high risk of early cardiovascular complications and premature death. The strongest modifiable risk factor is HbA1c. Other modifiable factors, such as overweight, also increase the risk of complications. During the last decade, the introduction of continuous glucose monitoring (CGM) has offered new options in the treatment of T1D. Objective: To compare treatment outcomes in children younger than 7 years with T1D in Sweden in two separate cohorts: one in 2008 and one in 2018. Methods: All children in the national pediatric diabetes registry (SWEDIABKIDS) younger than 7 years with T1D were included. Data from 2008 and 2018 were analyzed. Results: Data were available on 666 children (45% girls) in 2008 and 779 children (45% girls) in 2018. Mean age was 5.6 (1.4) versus 5.5 (1.4) years and mean diabetes duration 2.3 (1.4) versus 2.2 (1.4) years. The use of CGM increased from 0% to 98% and the use of an insulin pump from 40% in 2008 to 82% (p < 0.01)in 2018.Mean HbA1c was 58 mmol/mol (7.4%) in 2008 and 50 mmol/mol (6.7%) in 2018 (p < 0.01). The frequency of overweight and obesity was the same in 2008 and 2018(26% vs. 29%). Conclusion:During this decade, usage of CGM and insulin pump increased and HbA1c decreased. However, HbA1c remained higher than the physiological level and thus continued to represent a cardiovascular risk, especially in combination with overweight or obesity. The frequency of overweight and obesity remained unchanged.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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A decade of improved glycemic control in young children with type 1 diabetes: A population‐based cohort study

et al. 2021

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“…2,3 Consequently, many young children spend significant periods of time with glucose levels outside their recommended range. 4 The burden of care, which falls largely on parents, has been widely reported. 3,[5][6][7] Many parents/caregivers experience high levels of anxiety, with fears about hypoglycaemia being especially prominent.…”

Section: Introductionmentioning

confidence: 99%

“…Achieving and maintaining clinically recommended glucose levels in very young children presents profound challenges, due to insulin sensitivity, rapid growth, childhood infections, difficulties predicting food consumption and activity levels and children being unable to detect and report hypoglycaemia and hyperglycaemia reliably 2,3 . Consequently, many young children spend significant periods of time with glucose levels outside their recommended range 4 …”

Section: Introductionmentioning

confidence: 99%

Parents’ experiences of using remote monitoring technology to manage type 1 diabetes in very young children during a clinical trial: Qualitative study

et al. 2022

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Aims:To explore parents' experiences of using remote monitoring technology when caring for a very young child with type 1 diabetes during a clinical trial. Methods: Interviews were conducted with parents of 30 children (aged 1-7 years) participating in a trial (the KidsAP02 study) comparing hybrid closed-loop insulin delivery with sensor-augmented pump therapy. In both arms, parents had access to remote monitoring technology. Data analysis focused on identification of descriptive themes. Results: Remote monitoring technology gave parents improved access to data which helped them pre-empt and manage glucose excursions. Parents observed how, when children were in their own care, they could be more absent while present, as their attention could shift to non-diabetes-related activities. Conversely, when children were others' care, remote monitoring enabled parents to be present How to cite this article: Hart RI, Kimbell B, Rankin D, et al; the KidsAP Consortium. Parents' experiences of using remote monitoring technology to manage type 1 diabetes in very young children during a clinical trial: Qualitative study.

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The efficacy of insulin degludec and insulin glargine over NPH insulin among toddlers and preschoolers with type 1 diabetes using glycemic variability and time in range

2023

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Optimizing glycemic control without risking hypoglycemia is crucial in toddlers and preschoolers with type 1 diabetes (T1D) to avoid cognitive impairment later in life. Hence, this study aims to compare glycemic parameters among toddlers and preschoolers with T1D in relation to different basal insulins. Sixty toddlers and preschoolers with T1D with mean age of 3.53 ± 1.17 years (range, 2–6) and mean diabetes duration of 9.37 ± 1.85 months were randomly assigned into three equal groups; group A received insulin degludec, group B received insulin glargine, and group C were on NPH. At baseline, the three groups were matched regarding clinical and laboratory parameters (p > 0.05). They were followed up at 3 and 6 months for insulin daily dose (IDD), hypoglycemia and severe-hypoglycemia frequency, and glycated hemoglobin (HbA1c). At the study endpoint, continuous glucose monitoring (CGM) was assessed in a random sample of 10 patients from each group. The mean time in range (TIR) of the studied cohort was 55.07 ± 24.05%, and their mean coefficient of variation (CV) was 42.82 ± 11.69%. The TIR was significantly higher in the degludec group (69.36 ± 18.54) and the glargine group (55.43 ± 26.51) than the NPH group (32.56 ± 9.11), p < 0.001. Meanwhile, the CV was significantly lower in the degludec group (35.12 ± 6.47) than the gargine (44.1 ± 13.13) and the NPH (53.8 ± 7.54) groups, p < 0.001. The insulin degludec and glargine groups had significantly lower HbA1c (p = 0.002), hypoglycemia (p = 0.006), severe hypoglycemia (p = 0.029), and IDD (p = 0.015) than the NPH group.Conclusion: Insulin degludec and glargine resulted in better HbA1c and TIR with reduced hypoglycemia and IDD than NPH among toddlers and preschoolers with T1D. Moreover, CV was lowest in the insulin degludec group. What is Known:• Insulin therapy is the mainstay of T1D management.• Optimal insulin therapy for young children with T1D should provide effective glycemic. What is New:• Insulin degludec and insulin glargine have better efficacy than NPH insulin among toddlers and preschoolers with T1D in the term of significantly lower coefficient of variation, HbA1c and IDD and significantly higher time in range.• Insulin degludec and insulin glargine have better safety in the term of less hypoglycemia and severe hypoglycemia episodes than NPH insulin among toddlers and preschoolers with T1D.

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Time spent outside of target glucose range for young children with type 1 diabetes: a continuous glucose monitor study

Cited by 17 publications

References 29 publications

A decade of improved glycemic control in young children with type 1 diabetes: A population‐based cohort study

A decade of improved glycemic control in young children with type 1 diabetes: A population‐based cohort study

Parents’ experiences of using remote monitoring technology to manage type 1 diabetes in very young children during a clinical trial: Qualitative study

The efficacy of insulin degludec and insulin glargine over NPH insulin among toddlers and preschoolers with type 1 diabetes using glycemic variability and time in range

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