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Continuous Glucose Monitoring Versus Self-monitoring of Blood Glucose in Children with Type 1 Diabetes—The Pros and Cons

Published Online: May 14th 2012 US Endocrinology, 2012;8(1):27-9 DOI: http://doi.org/10.17925/USE.2012.08.01.27
Authors: Susana R Patton, Mark A Clements
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Abstract:
Overview

Glucose monitoring is essential for modern diabetes treatment and the achievement of near-normal glycemic levels. Monitoring of blood glucose provides the data necessary for patients to make daily management decisions related to food intake, insulin dose, and physical exercise and it can enable patients to avoid potentially dangerous episodes of hypo- and hyperglycemia. Additionally, monitoring can provide healthcare providers with the information needed to identify glycemic patterns, educate patients, and adjust insulin. Presently, youth with type 1 diabetes can self-monitor blood glucose via home blood glucose meters, or monitor glucose concentrations nearly continuously using a continuous glucose monitor. There are advantages and disadvantages to the use of either of these technologies. This article describes the two technologies and the research supporting their use in the management of youth with type 1 diabetes in order to weigh their relative pros and cons.

Keywords

Type 1 diabetes, children, monitoring, glycemic control

Article:

Type 1 diabetes is a disease that affects about 150,000 youths in the US.1,2 It is characterized by an absence of insulin production by the β-cells of the pancreas.1 Patients with type 1 diabetes must administer insulin, either via injection or insulin pump, to achieve near-normal glucose metabolism and avoid life-threatening ketoacidosis.1 Self-monitoring of blood glucose (SMBG) is a cornerstone of modern diabetes treatment.1 Monitoring of blood glucose provides the data necessary to make daily management decisions related to food intake, insulin do

Type 1 diabetes is a disease that affects about 150,000 youths in the US.1,2 It is characterized by an absence of insulin production by the β-cells of the pancreas.1 Patients with type 1 diabetes must administer insulin, either via injection or insulin pump, to achieve near-normal glucose metabolism and avoid life-threatening ketoacidosis.1 Self-monitoring of blood glucose (SMBG) is a cornerstone of modern diabetes treatment.1 Monitoring of blood glucose provides the data necessary to make daily management decisions related to food intake, insulin dose, and physical exercise. In addition, monitoring enables patients to avoid acute complications of type 1 diabetes, namely hypo- and hyperglycemia and diabetic ketoacidosis.1,3,4 Finally, healthcare providers use blood glucose data to identify glycemic patterns, to educate patients, and to adjust insulin.5 Monitoring has been made easier in modern diabetes therapy with the introduction of home blood glucose monitors, which allow patients to check their glucose levels quickly and provide an accurate measure of capillary glucose concentrations. The recent introduction of continuous glucose monitoring (CGM) devices, which measure glucose concentrations subcutaneously in interstitial fluid, offers patients an alternative to traditional SMBG, the relative benefit of avoiding multiple finger-sticks to measure glucose levels, and a wealth of glucose data. Both SMBG and CGM technologies offer clear advantages and disadvantages in diabetes management and both have empirical support demonstrating their efficacy related to promoting better long-term glycemic control (e.g., glycated hemoglobin [HbA1c]).6–8

The purpose of this article is to provide an overview of the technologies and the research supporting their use in the management of youth with type 1 diabetes in order to weigh their relative pros and cons.

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Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Susana R Patton, PhD, CDE, Associate Professor of Pediatrics, Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160-7330, US. E: spatton2@kumc.edu

Received

2012-06-04T00:00:00

References

  1. Silverstein J, Klingensmith G, Copeland K, et al., Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association, Diabetes Care, 2005;28:186–212.
  2. Liese AD, D’Agostino RB Jr, Hamman RF, et al., The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study, Pediatrics, 2006;118:1510–8.
  3. Benjamin EM, Self-monitoring of blood glucose: the basics, Clin Diabetes, 2002;20:45–7.
  4. Goldstein DE, Little RR, Lorenz RA, Tests of glycemia in diabetes, Diabetes Care, 2003;26(Suppl. 1):S106–8.
  5. Hirsch IB, Glycemic variability: it’s not just about A1C anymore! Diabetes Technol Ther, 2005;7:780–3.
  6. Ziegler R, Heidtmann B, Hilgard D, et al., Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes, Pediatr Diabetes, 2011;12:11–7.
  7. Anderson B, Ho J, Brackett J, et al., Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus, J Pediatr, 1997;130:257–65.
  8. Tamborlane WV, Beck RW, Bode BW, et al., Continuous glucose monitoring and intensive treatment of type 1 diabetes, N Engl J Med, 2008;359:1464–76.
  9. FDA Public Meeting, Clinical Accuracy Requirements for Point of Care Blood Glucose Meters, March 16, 2010. Available from: www.fda.gov/MedicalDevices/NewsEvents/Workshops Conferences/ucm187406.htm (accessed May 24, 2012).
  10. 2008 resource guide. Blood glucose monitoring and data management systems. Before you buy a blood glucose monitor (also known as a blood glucose meter), check with your doctor and diabetes educator. Make sure the one you choose is well suited to your particular needs, Diabetes Forecast, 2008;61:RG31–2, RG34–48.
  11. Bode BW, The accuracy and interferences in self-monitoring of blood glucose, US Endocrine Disease, 2007:46–8.
  12. Perwien AR, Johnson SB, Dymtrow D, Silverstein J, Blood glucose monitoring skills in children with Type I diabetes, Clin Pediatr (Phila), 2000;39:351–7.
  13. Rewers M, Pihoker C, Donaghue K, et al., Assessment and monitoring of glycemic control in children and adolescents with diabetes, Pediatr Diabetes, 2009;10(Suppl. 12):71–81.
  14. Le Floch JP, Bauduceau B, Lévy M, et al., Self-monitoring of blood glucose, cutaneous finger injury, and sensory loss in diabetic patients, Diabetes Care, 2008;31:e73.
  15. Wadwa RP, Fiallo-Scharer R, Vanderwel B, et al., Continuous glucose monitoring in youth with type 1 diabetes, Diabetes Technol Ther, 2009;11(Suppl. 1):S83–91.
  16. Nardacci EA, Bode BW, Hirsch IB, Individualizing care for the many: the evolving role of professional continuous glucose monitoring systems in clinical practice, Diabetes Educ, 2010;36(Suppl. 1):4S–19S; quiz 20S–21S.
  17. Kovatchev B, Anderson S, Heinemann L, Clarke W, Comparison of the numerical and clinical accuracy of four continuous glucose monitors, Diabetes Care, 2008;31:1160–4.
  18. Hirsch IB, Abelseth J, Bode BW, et al., Sensor-augmented insulin pump therapy: results of the first randomized treat-to-target study, Diabetes Technol Ther, 2008;10:377–83.
  19. Yates K, Hasnat Milton A, Dear K, Ambler G, Continuous glucose monitoring-guided insulin adjustment in children and adolescents on near-physiological insulin regimens: a randomized controlled trial, Diabetes Care, 2006;29:1512–7.
  20. Block JM, Buckingham B, Use of real-time continuous glucose monitoring technology in children and adolescents, Diabetes Spectr, 2008;21:84–90.

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