Related Experiment Video
Updated: Dec 4, 2025
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Timing of CGM initiation in pediatric diabetes: The CGM TIME Trial
Margaret L Lawson1,2, Kate C Verbeeten1,2, Jennilea M Courtney2
1Division of Endocrinology and Metabolism, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Insights
Initiating continuous glucose monitoring (CGM) simultaneously with insulin pump therapy improves CGM adherence in children with type 1 diabetes. Higher adherence is linked to better HbA1c control.
Area of Science:
- Pediatric Endocrinology
- Diabetes Technology
- Metabolic Disorders
Background:
- Type 1 diabetes (T1D) management in children and youth often involves insulin pump therapy.
- Continuous glucose monitoring (CGM) is a crucial tool for glycemic control in T1D.
- The integration of CGM with insulin pumps, including features like low glucose suspend (LGS), aims to optimize diabetes care.
Purpose of the Study:
- To evaluate if the timing of CGM initiation, alongside insulin pump therapy offering LGS, impacts CGM adherence in pediatric T1D patients.
- To compare simultaneous initiation versus delayed CGM initiation (6 months post-pump start) on adherence and glycemic outcomes.
Main Methods:
- A 5-site randomized controlled trial (RCT) involving 144 pump-naïve children and youth (5-18 years) with T1D.
- Comparison between simultaneous pump and CGM initiation with LGS versus standard pump therapy with delayed CGM initiation.
- Primary outcome: CGM adherence (hours/28 days) over 6 months; Secondary outcome: HbA1c.
Main Results:
- Simultaneous initiation resulted in significantly higher CGM adherence (62.4 hours/28 days greater) compared to delayed initiation (P = .007).
- No significant difference in mean HbA1c at 6 months between groups.
- A significant inverse association was found between CGM adherence and HbA1c (0.39% lower HbA1c per 100 hours of CGM use/28 days).
- Higher CGM adherence correlated with reduced time spent with glucose levels >10 mmol/L (P < .001).
Conclusions:
- Initiating CGM concurrently with insulin pump therapy enhances CGM adherence in pediatric T1D patients.
- Improved CGM adherence is associated with better glycemic control, including lower HbA1c levels.
- Early integration of CGM technology with insulin pumps is recommended for optimizing diabetes management in youth.
Objective:
To determine whether timing of CGM initiation offering low glucose suspend (LGS) affects CGM adherence in children and youth starting insulin pump therapy.
Methods:
A 5-site RCT of pump-naïve subjects (aged 5-18 years) with type 1 diabetes (T1D) for at least 1 year compared simultaneous pump and CGM initiation offering LGS vs standard pump therapy with CGM initiation delayed for 6 months. Primary outcome was CGM adherence (hours per 28 days) (MiniMed™ Paradigm™ Veo™ system; CareLink Pro™ software) over 6 months after CGM initiation. Secondary outcome HbA1c was measured centrally. Linear mixed-models and ordinary least squares models were fitted to estimate effect of intervention, and covariates baseline age, T1D duration, HbA1c, gender, ethnicity, hypoglycemia history, clinical site, and association between CGM adherence and HbA1c.
Results:
The trial randomized 144/152 (95%) eligible subjects. Baseline mean age was 11.5 ± 3.3(SD) years, T1D duration 3.4 ± 3.1 years, and HbA1c 7.9 ± 0.9%. Six months after CGM initiation, adjusted mean difference in CGM adherence was 62.4 hours per 28 days greater in the Simultaneous Group compared to Delayed Group (P = .007). There was no difference in mean HbA1c at 6 months. However, for each 100 hours of CGM use per 28-day period, HbA1c was 0.39% (95% CI 0.10%-0.69%) lower. Higher CGM adherence was associated with reduced time with glucose >10 mmol/L (P < .001).
Conclusion:
CGM adherence was higher after 6 months when initiated at same time as pump therapy compared to starting CGM 6 months after pump therapy. Greater CGM adherence was associated with improved HbA1c.
