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Realtime Continuous Glucose Monitoring in Children and Adolescents— An Overview of the Current Technology and its Impact on Patient Outcomes

Published Online: May 14th 2012 US Endocrinology, 2012;8(1):30-4 DOI: http://doi.org/10.17925/USE.2012.08.01.30
Authors: Jeniece Trast, Neesha Ramchandani
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Abstract:
Overview

Continuous glucose monitoring (CGM) systems, available for patient use since 1999, and realtime continuous glucose monitoring (RT-CGM) systems, available since 2006, have helped optimize diabetes management. Previously, RT-CGM studies found benefits mainly in patients with type 1 diabetes over the age of 25. Children and adolescents often present a challenge when managing type 1 diabetes. However, it is now apparent that RT-CGM has clear benefits in these age groups as well as in adults. Not only have studies shown improvements in glycemic control in this population, they have also demonstrated parental satisfaction with the technology. Challenges with RT-CGM use still exist and must be addressed. Nevertheless, RT-CGM is a beneficial tool to assist in diabetes management, and its use should be encouraged in the majority of pediatric patients with type 1 diabetes.

Keywords

Type 1 diabetes, continuous glucose monitoring system, pediatric patients, children, adolescents, glucose sensor, diabetes technology

Article:

Continuous glucose monitoring (CGM) systems have been available for patient use since 1999 and realtime continuous glucose monitoring (RT-CGM) systems have been available since 2006.1 The early systems were blinded and used as a tool by diabetes clinicians for diagnostic purposes (diagnosis of hypo- and hyperglycemia) and to get a more complete picture of a patient’s blood sugar trends over several consecutive days.

Continuous glucose monitoring (CGM) systems have been available for patient use since 1999 and realtime continuous glucose monitoring (RT-CGM) systems have been available since 2006.1 The early systems were blinded and used as a tool by diabetes clinicians for diagnostic purposes (diagnosis of hypo- and hyperglycemia) and to get a more complete picture of a patient’s blood sugar trends over several consecutive days. Data on glucose values, measured every five minutes in the interstitial fluid, could be reviewed only after they had been downloaded from the CGM device onto a computer. Since then, newer systems have been developed and improved upon, and are becoming increasingly accepted by patients with type 1 diabetes. Blinded CGM systems still exist in updated versions (e.g., Medtronic’s iPro®) and are used for diagnostic and research purposes. However, the advent of RT-CGM allows patients to see their own glucose values and trends in realtime and intervene as necessary.

Currently, people with type 1 diabetes of all ages use RT-CGM, which helps them optimize their glycemic control. By having RT-CGM information on glucose levels every one to five minutes, patients and parents/care-givers are able to make more educated decisions when adjusting insulin, activity, and food intake. It enables them to have more control over their own or their child’s diabetes. Many studies have been done to evaluate the efficacy and benefits of RT-CGM, although few have specific information regarding RT-CGM use and benefits in children and adolescents.2

It can be challenging to maintain euglycemia in children and adolescents with type 1 diabetes due to their eating habits, growing and changing bodies, erratic schedules, still developing cognitive systems, inability to manage their diabetes on their own, and presence of multiple care-givers. RT-CGM systems can be used in this group of patients to more closely monitor their varying glucose levels and help them achieve good glycemic control. Previously, studies of patients with type 1 diabetes using CGM did not show the same benefits in the younger population as in adults.3–5 However, recent reports have found benefits of using RT-CGM in youth.6–10 RT-CGM use in children and adolescents has increased, but it is still not as wide as in adults.

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Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Neesha Ramchandani, PNP, CDE, Division of Pediatric Endocrinology and Diabetes, The Children’s Hospital at Montefiore, 3415 Bainbridge Ave., Bronx, NY 10467, US. E: neesha.ramchandani@gmail.com

Received

2012-06-06T00:00:00

References

  1. Medtronic, Innovation Milestones. Available from www.medtronicdiabetes.net/aboutmedtronic/innovationmilest ones (accessed June 21, 2012).
  2. Szypowska A, Ramotowska A, Dzygalo K, Golicki D, Beneficial effect of real-time continuous glucose monitoring system on glycemic control in type 1 diabetic patients: systematic review and meta-analysis of randomized trials, Eur J Endocrinol, 2012;166:567–74.
  3. Beck RW, Hirsch IB, Laffel L, et al., The effect of continuous glucose monitoring in well-controlled type 1 diabetes, Diabetes Care, 2009;32:1378–83.
  4. 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.
  5. Hoeks LB, Greven WL, de Valk HW, Real-time continuous glucose monitoring system for treatment of diabetes: a systematic review, Diabet Med, 2011;28:386–94.
  6. Ly TT, Hewitt J, Davey RJ, et al., Improving epinephrine responses in hypoglycemia unawareness with real-time continuous glucose monitoring in adolescents with type 1 diabetes, Diabetes Care, 2011;34:50–2.
  7. Wojciechowski P, Rys P, Lipowska A, et al., Efficacy and safety comparison of continuous glucose monitoring and selfmonitoring of blood glucose in type 1 diabetes: systematic review and meta-analysis, Pol Arch Med Wewn, 2011;121:333–43.
  8. Medtronic, mySentry remote glucose monitor. Available at: www.medtronicdiabetes.com/products/mySentry (accessed June 22, 2012).
  9. Singer E, Cars warn when your blood sugars are low, Technology Review, October 14, 2011. Available at: www.technologyreview.com/biomedicine/38890/ (accessed June 22, 2012).
  10. Peyrot M, Rubin RR, Patient-reported outcomes for an integrated real-time continuous glucose monitoring/insulin pump system, Diabetes Technol Ther, 2009;11:57–62.
  11. 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.
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  13. Bergenstal RM, Tamborlane WV, Ahmann A, et al., Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes, N Engl J Med, 2010;363:311–20.
  14. Tsalikian E, Fox L, Weinzimer S, et al., Feasibility of prolonged continuous glucose monitoring in toddlers with type 1 diabetes, Pediatr Diabetes, 2012;13:294–300.
  15. Mauras N, Beck R, Xing D, et al., A randomized clinical trial to assess the efficacy and safety of real-time continuous glucose monitoring in the management of type 1 diabetes in young children aged 4 to <10 years, Diabetes Care, 2012;35:204–10.

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