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Is there an optimal strategy for real-time continuous glucose monitoring in pediatrics? A 12-month French

Sophie Guilmin-Crépon1,2,3,4, Jean-Claude Carel1,5,4, Julien Schroedt2,3

  • 1Pediatric Endocrinology and Diabetology Department and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, CHU Robert Debré, AP-HP, Paris, France.

Pediatric Diabetes
|January 22, 2019
PubMed

Insights

Real-time continuous glucose monitoring (RT-CGM) strategies showed no difference in HbA1c for type 1 diabetes in children. Three months of RT-CGM use reduced severe hypoglycemia, confirming feasibility and highlighting educational needs.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Diseases
  • Biomedical Engineering

Background:

  • Type 1 diabetes management in children and adolescents requires effective glucose monitoring.
  • Real-time continuous glucose monitoring (RT-CGM) offers potential benefits but optimal long-term strategies are unclear.
  • Understanding the comparative efficacy of different RT-CGM usage patterns is crucial for clinical practice.

Purpose of the Study:

  • To compare the efficacy of three distinct RT-CGM strategies over 12 months in pediatric patients with type 1 diabetes.
  • To evaluate the impact of RT-CGM on glycemic control (HbA1c) and acute metabolic events.
  • To assess patient satisfaction, hypoglycemia rates, and associated costs with different RT-CGM protocols.

Main Methods:

  • A randomized, controlled, prospective trial involving 151 children and adolescents (2-17 years) with type 1 diabetes.
  • Patients initially used RT-CGM for 3 months, then were randomized to: self-monitoring of blood glucose, continuous RT-CGM (80% time), or discontinuous RT-CGM (40% time).
  • Primary outcome was HbA1c change from 3 to 12 months; secondary outcomes included metabolic events, hypoglycemia, satisfaction, and cost.

Main Results:

  • No significant differences in HbA1c levels were observed among the three RT-CGM groups over the 12-month study period.
  • The rate of severe hypoglycemia significantly decreased across the entire study population after 3 months of RT-CGM use.
  • Consistent device use and good tolerance were reported by subjects, irrespective of age or insulin regimen; full-time RT-CGM cost €2629 per patient over 3 months.

Conclusions:

  • None of the evaluated long-term RT-CGM strategies demonstrated superiority in improving HbA1c levels for pediatric type 1 diabetes.
  • Short-term RT-CGM use (3 months) effectively reduced severe hypoglycemia rates.
  • The study confirms the feasibility of long-term RT-CGM use and underscores the necessity for enhanced educational support for patients and caregivers.
Abstract

Keywords:
adolescentchildrencontinuous glucose monitoringcoststype 1 diabetes

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