Recommendations for the use of sensor-augmented pumps with predictive low-glucose suspend features in children: The importance of education

Abstract

Sensor-augmented pumps, which consist of a pump and a continuous glucose monitoring system, offer considerable therapeutic opportunities, despite requiring close attention in the early phase of their use. The aim of this paper is to provide recommendations on the use of a predictive low glucose management (PLGM) system (Minimed 640G™, Medtronic, Northridge, CA, USA) in adolescents with type 1 diabetes either at the start of therapy or during follow-up. Sound clinical recommendations on PLGM are of increasing importance since several recent papers have reported significant clinical improvements in patients with PLGM, especially in adults. These recommendations are based on the experience of a group of pediatric endocrinologists who collaborated to closely and intensively study the on-boarding of adolescent patients with type 1 diabetes on automated systems to gain first-hand experience and peer-to-peer insights in a unique free-living environment. The suggestions provided here are indicative, so can be adapted to the individual realities and experiences of different diabetes centers. However, we believe that close adherence to the proposed scheme is likely to increase the chances of improving the clinical and metabolic outcomes of patients treated with this therapy.

Optimal predictive low glucose management settings during physical exercise in adolescents with type 1 diabetes

“…Subjects were recruited from 12 Centers of 10 Italian regions (Piedmont, Lombardy, Liguria, Lazio, Tuscany, Marche, Abruzzo, Puglia, Sicily, and Sardinia). All of the teenagers participating in the camp were using a MiniMed 640G, with different PLGM thresholds as instructed by their local physicians . Physicians and teenagers were informed that during the camp, the medical staff might request the participant to modify their PLGM thresholds.…”

“…All of the teenagers participating in the camp were using a MiniMed 640G, with different PLGM thresholds as instructed by their local physicians. 8 Physicians and teenagers were informed that during the camp, the medical staff might request the participant to modify their PLGM thresholds. The local Research Ethical Committee approved the study.…”

Effectiveness of a closed‐loop control system and a virtual educational camp for children and adolescents with type 1 diabetes: A prospective, multicentre, real‐life study

“…Unlike scheduled contacts between patients and the diabetes team typical of randomized clinical trials, the children and adolescents who participated in our study were followed up at routine clinical visits every 3 months. The upgrade from Basal‐IQ to Control‐IQ technology was made using a similar approach in all participating centres, adopting a standardized systematic approach as previously reported 4,6 . Indeed, because there are notable differences between semi‐automated systems like Minimed 640G and Control‐IQ, we developed the vEC programme to offer additional educational support by involving children, parents and diabetes teams.…”

“…3 Nevertheless, CLC systems still require motivational and educational input, and the need for adequate education to maximize the benefits of new diabetes technology is well established. [4][5][6] A basic level of education is required for most new diabetes technologies, such as the need to count carbohydrates and administer an adequate food bolus well in advance of dosing. Users of hybrid systems benefit from additional training, because the technology is complex and requires personalized settings including basal rates, insulin correction factors and insulin-to-carbohydrate ratios.…”

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies

“…Success with SAP, in many ways, hinges on integration and understanding of the system components, namely the CGM and pump. Scaramuzza et al have provided a framework by which to initiate PLGS in children . Topics that should be considered when initiating these therapies may include expected frequency of sensor use, and how treatment may vary when breaks from sensor therapy may occur.…”