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[Continuous glucose monitoring with type 1 diabetes mellitus]
J P López-Siguero1, M J García Arias, A del Pino de la Fuente
1Sección de Endocrinología Pediátrica. Hospital Materno-Infantil. Complejo Hospitalario Carlos Haya. Málaga. España.
Insights
Continuous glucose monitoring reveals that conventional insulin therapy often fails to achieve glycemic goals in children with type 1 diabetes. This method also uncovers numerous asymptomatic hypoglycemic episodes, particularly at night.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Context:
- Type 1 diabetes mellitus (DM) management in children relies on capillary glucose monitoring.
- Current methods inadequately capture glycemic fluctuations, missing postprandial hyperglycemia and nocturnal hypoglycemia.
Purpose:
- To evaluate pre- and postprandial blood glucose levels in children with type 1 DM.
- To identify the occurrence and duration of hypoglycemic episodes using continuous glucose monitoring.
Summary:
- Seventeen children (mean age 12) with type 1 DM were monitored using a continuous glucose monitoring system (CGMS).
- Results showed high mean preprandial (144.9–160.5 mg%) and postprandial (230.4–248.8 mg%) glucose levels.
- CGMS detected significantly more hypoglycemic episodes (4.9) than glucometers (1.8), including prolonged, asymptomatic nocturnal hypoglycemia.
Impact:
- Continuous subcutaneous glucose monitoring highlights that conventional insulin therapy falls short of achieving glycemic targets in pediatric type 1 DM.
- The study underscores a high prevalence of undetected, asymptomatic hypoglycemia, particularly nocturnal episodes.
Background:
Appropriate metabolic control of children with type 1 diabetes mellitus (DM) is based on frequent measurements of capillary glycemia. However, this method offers only partial information on fluctuations in glycemia during the day, while episodes of postprandial hyperglycemia and hypoglycemia, mainly nocturnal, go unnoticed.
Objectives:
To analyze pre- and postprandial blood glucose levels, as well as the presence and duration of hypoglycemic episodes in diabetic children aged more than 8 years old with more than one year of disease duration.
Methods:
Seventeen patients of both sexes (mean age: 12 years old) with type 1 DM were monitored with the continuous glucose monitoring system (CGMS) during working days. Maximum values of pre- and postprandial glucose (1-3 hours after breakfast, lunch and dinner) were registered. Data were downloaded with a Com-station.
Results:
The mean duration of sensor-wearing was 2.97 days. Pre- and postprandial values were high: mean preprandial values were between 144.9 and 160.5 mg % and mean postprandial values were between 230.4 and 248.8 mg %. The mean number of hypoglycemic episodes detected with the sensor was 4.9 compared with 1.8 detected with the glucometer (p < 0.05). Episodes of mainly nocturnal asymptomatic hypoglycemia were detected with a mean duration of 145 minutes during the night and 75 minutes during the day.
Conclusions:
The use of continuous subcutaneous glucose monitoring demonstrates that glycemic objectives are not achieved by conventional insulin therapy. It also shows that there are a high number of hypoglycemic episodes, most of which are asymptomatic.