Use of a real-time continuous glucose monitoring system in children and young adults on insulin pump therapy: Patients’ and caregivers’ perception of benefit

Helen DeVos Children's Hospital, Spectrum Health, Pediatric Endocrinology and Diabetes Clinic, 230 Michigan Street NE, Suite 101, MC 77, Grand Rapids, Michigan, 49503, USA.
Pediatric Diabetes (Impact Factor: 2.57). 12/2009; 11(3):182-7. DOI: 10.1111/j.1399-5448.2009.00549.x
Source: PubMed


Real-time continuous glucose monitoring systems (RT-CGMS) are a recently introduced technology for type 1 diabetes and experience in children is limited.
To assess patient and caregiver's perception of benefits and disadvantages of RT-CGMS in children or young adults with type 1 diabetes mellitus (DM) on insulin pump therapy.
Forty-three subjects (3-25 yr) on insulin pump therapy were included in the study. Thirty-four used RT-CGMS for a short-term trial (4 wk, ST group) and nine as a long-term tool (2-18 months, LT group). Forty subjects or their caregivers completed a questionnaire.
On the basis of the questionnaire responses, hypoglycemia prevention was the most common perceived benefit (88%), followed by elimination of hypoglycemia-related anxiety (83%), ease of pattern management (85%), improvement of diabetes control (80%), improvement of quality of life (78%), and ease of diabetes care (78%). Negative effects included irritation/annoyance from the sensor alarm (48%) and insertion site bruising, pain, or irritation (43%). A small percentage of patients who were interested in purchasing the device (12%) decided against using it LT after a 4-wk trial on RT-CGMS.
The most common perceived benefits of RT-CGMS are prevention of hypoglycemia and decrease in hypoglycemia-related anxiety. Negative effects are uncommon and seem to be unlikely to affect the decision to use RT-CGMS for a LT. A ST trial seems to be a valuable tool for the patient/caregiver in determining whether to purchase the device and in setting realistic expectations of its potential benefits.

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    • "Accordingly, there is increasing interest among pediatric endocrinologists in using CGM to improve HbA1c levels and reduce the incidence of hypoglycemia in children. This corresponds with patient/family interest in CGM as a means to prevent hypoglycemia primarily, and improve diabetes control secondarily [7]. The full clinical potential impact of CGM, however, is far from being realized since most children with T1D do not use or have access to this resource for their diabetes care [4]. "
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    ABSTRACT: Continuous glucose monitoring (CGM), while a relatively new technology, has the potential to transform care for children with type 1 diabetes. Some, but not all studies, have shown that CGM can significantly improve hemoglobin A1c levels and reduce time spent in the hypoglycemic range in children, particularly when used as part of sensor-augmented pump (SAP) therapy. Despite the publication of recent clinical practice guidelines suggesting CGM be offered to all children 8 years of age or older who are likely to benefit, and studies showing that younger children can also benefit, this technology is not yet commonly used by children with type 1 diabetes. Effects of CGM are enhanced when used on a near-daily basis (a use-dependent effect) and with insulin pump therapy. Therefore, coordinated strategies are needed to help children and their families initiate and continue to use this resource for diabetes care. This review introduces CGM to pediatric endocrinologists who are not yet familiar with the finer details of this technology, summarizes current data showing the benefits and limitations of CGM use in children, reviews specific case examples demonstrating when CGM can be helpful, and shows the value of both retrospective and real-time CGM. It is hoped that this information leads to discussion of this technology in pediatric endocrinology clinics as an important next step in improving the care of children with type 1 diabetes.
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