Early Initiation of Intermittently Scanned Continuous Glucose Monitoring in a Pediatric Population With Type 1 Diabetes: A Real World Study

Abstract

BackgroundUse of Continuous Glucose Monitoring (CGM) systems early in the course of diabetes has the potential to help glycemic management and to improve quality of life (QoL). No previous research has examined these outcomes in children-adolescents with type 1 diabetes (T1D) who use intermittently scanned CGM (isCGM) starting within the first month after diagnosis.AimTo evaluate the impact of isCGM early after T1D diagnosis, on metabolic control and QoL, comparing a group who started the use of the device within one month from the onset with another one who started at least one year later.Subjects and MethodsPatients who used isCGM within 1 month from T1D diagnosis were enrolled in group A; those who didn’t have the device during the first year were considered as control group (group B). HbA1c and total daily insulin were evaluated at 3 (T1), 6 (T2) and 12 (T3) months post-baseline (T0, diabetes onset), QoL after 1 year. In group A, isCGM glucose metrics were also recorded.Results85 patients were enrolled in group A and 67 patients in group B. In group A isCGM was well accepted during follow up: no patient dropped out; percentage of time with active sensor was in mean > 87%; number of scans/day remained stable. QoL was higher in group A than in group B both in children-adolescents (p<0.0001) and in parents (p 0.003). Group A presented lower HbA1c during the first year after diagnosis (p<0.001), and this data correlated with glucose management indicator (GMI), time in range (TIR) and mean glucose. The honeymoon period lasted more in group A than in B (p 0.028). Furthermore, the mean hypoglycemia duration decreased during follow-up (p 0.001) in group A.ConclusionsEarly use of isCGM, starting within the first month after diagnosis, improves metabolic control and QoL in pediatric patients with T1D.

Time in Range in Children with Type 1 Diabetes before and during a Diabetes Camp—A Ceiling Effect?

“…As the increase in daily scans pre-camp to camp was strongly associated with the improvement in TIR, the number of scans seem to have been a key to success in the isCGM group. This is an interesting finding, as the number scans in our study, are much higher than in other studies [9,[24][25][26][27]. A Suisse study in children with a T1D reported 6.5-9 scans per day [26], an Italian study reported a consistent number of 10 scans per day over the period of 1 year [25].…”

“…This is an interesting finding, as the number scans in our study, are much higher than in other studies [9,[24][25][26][27]. A Suisse study in children with a T1D reported 6.5-9 scans per day [26], an Italian study reported a consistent number of 10 scans per day over the period of 1 year [25]. The ALERTT1 study [9] in adults reported 11 scans per day.…”

“…The ALERTT1 study [ 9 ] in adults reported 11 scans per day. Furthermore, although the average number of daily scans documented pre-camp (13 scans per day) had also been higher than in other studies [ 9 , 24 , 25 , 26 , 27 ], apparently isCGM systems were still sub-optimally scanned at home. Therefore, it might be reasonable to advice patients with isCGM systems to scan devices even more frequently, especially when glycemic fluctuations are likely to be expected.…”

An updated algorithm for an effective choice of continuous glucose monitoring for people with insulin-treated diabetes

“…Moreover, the analysis of glucose pattern may be used as an educational tool to demonstrate the relationship between an individual’s glucose levels, his/her medication, and other therapeutic interventions. There is evidence from observational studies that the early use (within one year from the diagnosis) of both isCGM [ 23 ] and rtCGM [ 24 – 26 ] results in long-term improvement in HbA 1c and the reduction in diabetes-related emergency-department admissions in people with type 1 diabetes. Moreover, the use of CGM at the onset of diabetes allows patients to be aware of the glycemic trends and their changes following insulin therapy.…”

Influence of Parental Health Locus of Control on Behavior, Self-Management and Metabolic Control, in Pediatric Patients with Type 1 Diabetes

“…No. 225 patients with diabetes, aged 1–18 years were followed up in April 2022 [ 12 ], and participants (children–adolescents and their caregivers) were selected according to the following inclusion criteria:…”