The Medtronic MiniMed Gold Continuous Glucose Monitoring System: An Effective Means to Discover Hypo- and Hyperglycemia in Children Under 7 Years of Age
Department of Pediatrics , Stanford University, Stanford, California, United States Diabetes Technology & Therapeutics
(Impact Factor: 2.11).
08/2007; 9(4):307-16. DOI: 10.1089/dia.2007.0026
The glycemic patterns of children less than 7 years with type 1 diabetes have not been well studied using continuous glucose monitoring. Our goal was to assess the incidence of hypoglycemia as well as postprandial glycemic patterns in this age group utilizing continuous glucose monitoring.
Nineteen children used the Medtronic MiniMed (Northridge, CA) CGMS System Gold on three to seven occasions over approximately 6 months.
Nineteen children (nine girls and 10 boys; mean age 4.8 +/- 1.4 years, range 1.6-6.8 years) used the CGMS 102 times, providing 434 days of data; 79% of days were optimal based on CGMS Solutions software version 3.0. Mild hypoglycemia (glucose <or=70 mg/dL) was noted during 28% of 323 nights. When compared to paired meter blood glucose values, the false-positive rate was 16% for mild and 55% for severe sensor hypoglycemia. The mean peak glucose during the 3 h following breakfast (247 +/- 64 mg/dL) was higher than following lunch (199 +/- 67 mg/dL) or dinner (194 +/- 63 mg/dL). The rate of glucose rise to peak was >or=2 mg/dL/min following 50% of breakfasts. Children with hemoglobin A1c levels >or=8% had higher postprandial glucose concentrations. There was no significant advantage of continuous subcutaneous insulin infusion therapy over multiple daily injection therapy in decreasing postprandial hyperglycemia.
CGMS tracings from young children with diabetes demonstrate frequent mild nocturnal hypoglycemia and significant postprandial hyperglycemia, with a rapid rise in glucose following the meal. The most rapid rate of rise and the most severe postprandial hyperglycemia occurred after breakfast.
Available from: Noelle S Larson
- "The graphs and summary data generated can help patients and diabetes team members adjust their therapy. Small trials in children have shown these retrospective devices to be helpful in identifying post-prandial hyperglycemia and asymptomatic overnight hypoglycemia [10-12]. "
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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.
Available from: Michael SD Agus
- "Furthermore, children diagnosed with type 1 diabetes at a younger age have increased risk of long-term neurocognitive dysfunction, which may be related to episodes of severe hypoglycemia (10,11). A study of CGM in children aged <7 years found that episodes of hypoglycemia occurred on 28% of nights (12). This problem will only become of greater significance, as the incidence of type 1 diabetes is increasing worldwide with the most rapid increase in children aged <5 years (13). "
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To assess the possibility of improving nocturnal glycemic control as well as meal glycemic response using closed-loop therapy in children aged <7 years.RESEARCH DESIGN AND METHODS
This was a randomized controlled crossover trial comparing closed-loop with standard open-loop insulin pump therapy performed in an inpatient clinical research center. Ten subjects aged <7 years with type 1 diabetes for >6 months treated with insulin pump therapy were studied. Closed-loop therapy and standard open-loop therapy were compared from 10:00 p.m. to 12:00 p.m. on 2 consecutive days. The primary outcome was plasma glucose time in range (110-200 mg/dL) during the night (10:00 p.m.-8:00 a.m.). Secondary outcomes included peak postprandial glucose levels, incidence of hypoglycemia, degree of hyperglycemia, and prelunch glucose levels.RESULTSA trend toward a higher mean nocturnal time within target range was noted for closed versus open-loop therapy, although not reaching statistical significance (5.3 vs. 3.2 h, P = 0.12). There was no difference in peak postprandial glucose or number of episodes of hypoglycemia. There was significant improvement in time spent >300 mg/dL overnight with closed-loop therapy (0.18 vs. 1.3 h, P = 0.035) and the total area under the curve of glucose >200 mg/dL (P = 0.049). Closed-loop therapy returned prelunch blood glucose closer to target (189 vs. 273 mg/dL on open loop, P = 0.009).CONCLUSIONS
Closed-loop insulin delivery decreases the severity of overnight hyperglycemia without increasing the incidence of hypoglycemia. The therapy is better able to reestablish target glucose levels in advance of a subsequent meal. Younger children with type 1 diabetes may reap significant benefits from closed-loop therapy.
Available from: Naama Barnea-Goraly
- "Children diagnosed with the onset of type 1 diabetes before 5 years of age have impaired performance in memory, attention, visual-perceptual function, and fine motor speed/coordination (1,2). Young children with type 1 diabetes have the greatest excursions in blood glucose (BG) values (3) because of their irregular eating patterns and inability to recognize and report symptoms of hypoglycemia or hyperglycemia. Both hypoglycemia (4,5) and hyperglycemia (6,7) have been associated with neurocognitive effects and brain volume differences (8). "
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To detect clinical correlates of cognitive abilities and white matter (WM) microstructural changes using diffusion tensor imaging (DTI) in young children with type 1 diabetes.
RESEARCH DESIGN AND METHODS
Children, ages 3 to <10 years, with type 1 diabetes (n = 22) and age- and sex-matched healthy control subjects (n = 14) completed neurocognitive testing and DTI scans.
Compared with healthy controls, children with type 1 diabetes had lower axial diffusivity (AD) values (P = 0.046) in the temporal and parietal lobe regions. There were no significant differences between groups in fractional anisotropy and radial diffusivity (RD). Within the diabetes group, there was a significant, positive correlation between time-weighted HbA1c and RD (P = 0.028). A higher, time-weighted HbA1c value was significantly correlated with lower overall intellectual functioning measured by the full-scale intelligence quotient (P = 0.03).
Children with type 1 diabetes had significantly different WM structure (as measured by AD) when compared with controls. In addition, WM structural differences (as measured by RD) were significantly correlated with their HbA1c values. Additional studies are needed to determine if WM microstructural differences in young children with type 1 diabetes predict future neurocognitive outcome.
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