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Continuous subcutaneous glucose monitoring in children with type 1 diabetes
1Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, Denver, Colorado 80262, USA. peter.chase@uchsc.edu
Insights
Continuous subcutaneous glucose monitoring (CGMS) effectively detects nocturnal hypoglycemia in children with type 1 diabetes. This technology also helps lower hemoglobin A1c (HbA1c) levels without increasing severe hypoglycemia risk.
Area of Science:
- Pediatric Endocrinology
- Diabetes Technology
- Metabolic Disorders
Background:
- Type 1 diabetes management in children requires careful glucose control.
- Nocturnal hypoglycemia is a significant concern in pediatric type 1 diabetes.
- Hemoglobin A1c (HbA1c) is a key indicator of long-term glycemic control.
Purpose of the Study:
- To evaluate continuous subcutaneous glucose monitoring (CGMS) for detecting unrecognized nocturnal hypoglycemia in children with type 1 diabetes.
- To assess the impact of CGMS on lowering HbA1c levels.
- To determine if CGMS use increases the risk of severe hypoglycemia.
Main Methods:
- A randomized trial involving eleven children with type 1 diabetes and HbA1c >8.0%.
- Participants were assigned to either the CGMS group or a control group.
- The CGMS group used multiple 3-day sensors over 30 days; both groups self-monitored blood glucose.
Main Results:
- The CGMS group identified numerous asymptomatic nocturnal hypoglycemia episodes.
- Children using CGMS showed a significant decrease in mean HbA1c after 30 days compared to baseline.
- After 3 months, CGMS users maintained lower HbA1c levels; no severe hypoglycemia occurred in either group.
Conclusions:
- Continuous subcutaneous glucose monitoring is effective in detecting asymptomatic nocturnal hypoglycemia in children with type 1 diabetes.
- CGMS use contributes to lowering HbA1c levels in this population.
- The use of CGMS does not elevate the risk of severe hypoglycemia.
Purpose:
To determine whether the use of continuous subcutaneous glucose monitoring will help in detecting unrecognized nocturnal hypoglycemia and in lowering hemoglobin A1c (HbA1c) levels (without increasing the risk for severe hypoglycemia) in children with type 1 diabetes.
Methods:
Eleven children with type 1 diabetes and HbA1c values consistently >8.0% were randomized either to the Continuous Glucose Monitoring System (CGMS) group or to the control group. The CGMS group used 6 3-day sensors within a 30-day period. Both groups self-monitored their blood glucose levels a minimum of 4 times daily. HbA1c levels were measured at the start, at 1-month, and after 3 months of study.
Results:
The 5 children using the CGMS had 17 asymptomatic episodes (85%) of glucose levels below 60 mg/dL (3.25 mmol/L) and 3 symptomatic episodes (15%) during the night in the study month. The 6 control children had 4 symptomatic nocturnal low episodes during the month. After the 30-day period of wearing the CGMS, the 5 children had a significantly lower mean HbA1c value compared with their initial value (mean +/- standard error of the mean [SEM] decrease =.36% +/-.07%). The mean decrease for the controls was.2% +/-.2%. After 3 months, 4 of the 5 children who used the CGMS continued to have lower HbA1c values in comparison to their initial values (mean +/- SEM decrease = 1.04% +/-.43%). Three of the 6 control participants also had lower HbA1c values at 3 months (mean +/- SEM decrease for the group =.62% +/-.44%). No severe hypoglycemic events occurred in either the CGMS or the control groups.
Conclusion:
In this pilot trial, continuous subcutaneous glucose monitoring was helpful in detecting asymptomatic nocturnal hypoglycemia as well as in lowering HbA1c values without increasing the risk for severe hypoglycemia in children with type 1 diabetes.