Real-Time Continuous Glucose Monitoring in Children and Adolescents

Abstract

Recent large databases of patients with type 1 diabetes in the European Union and the USA have demonstrated that most patients, particularly in the pediatric patient group, do not reach the target values of glycosylated hemoglobin (HbA 1c ) recommended by professional societies. Diabetes-related technology is associated with improved HbA 1c in many but not all randomized controlled trials (RCTs) that included pediatric patients. Recently, a few studies have demonstrated a significant reduction in exposure to hypoglycemia, to which pediatric patients are particularly vulnerable. Scientific evidence supports the use of real-time continuous glucose monitoring (RT-CGM) in all age groups. Data from RCTs for children and adolescents with type 1 diabetes clearly demonstrate a significant reduction in HbA 1c as well as a reduction in time spent in and/or frequency of hypoglycemia. However, the effectiveness of RT-CGM depends on its continuous use, and in some pediatric RCTs low compliance with the sensor use precludes significant improvements in metabolic control. RT-CGM with low-glucose threshold insulin suspend seems to effectively prevent and shorten hypoglycemia in all age groups. Several barriers have hindered wider routine use of RT-CGM in children and adolescents, such as poor reimbursement in public insurance systems, insufficient training of diabetes care teams, age-specific behavior peculiarities, and lack of essential motivation for improving diabetes care and outcomes. Evidence-based strategies and quality assurance initiatives can help improve the organization of diabetes care for young patients along with individualized therapy plans that include the use of diabetes-related technology. Finally, RT-CGM integrated into closed-loop insulin delivery systems will enable more patients to reach glycemic targets with less day-to-day hassles. © 2015 S. Karger AG, BaselImmense efforts and finances have been invested in routine diabetes management, clinical research, and development of novel treatment strategies to improve day-today metabolic control in millions of patients with diabetes. Despite this, only a minority of patients with type 1 diabetes reach current targets for metabolic control. In the

Electrochemical Glucose Biosensors for Diabetes Care

“…Studies are beginning to show that the use of CGM can result in a reduction of HbA 1c in selected patient groups as well as decrease severe hypoglycemia [262,263]. The American Diabetes Association statement of Standards of Medical Care in Diabetes 2014 indicates that under certain circumstances, CGM can improve the glycemic control of patients with T1 and T2 diabetes, even those under relatively good control [2].…”

“…The American Diabetes Association statement of Standards of Medical Care in Diabetes 2014 indicates that under certain circumstances, CGM can improve the glycemic control of patients with T1 and T2 diabetes, even those under relatively good control [2]. Studies which demonstrate improvements in glycemic control in children are mounting [263,264]. Nevertheless, many insurance providers limit reimbursement to cases in which specific problems in glycemic control are documented, such as frequent hypoglycemia, hypoglycemic unawareness, and failure to maintain good glycemic control as determined by HbA 1c values.…”

Type 1 Diabetes in the Young: Organization of two National Centers in Israel and Slovenia / Sladkorna Bolezen Tipa 1 Pri Otrocih in Mladostnikih: Organizacija Dela V Dveh Nacionalnih Centrih V Izraelu in Sloveniji

“…Extensive evidence indicates that near-normalization of blood glucose levels is seldom attainable in children and adolescents after the remission period ( 30 – 32 ).Therefore, the development of CGM ( 33 ) may help children and adolescents with T1D improve their metabolic control ( 34 , 35 ) and reduce the time spent in hypoglycemia ( 32 , 36 ), as well as help their families to cope with the stress of day-to-day diabetes management ( 37 – 39 ).…”