Although the use of continuous glucose monitors (CGMs) in clinical practice has drastically increased over the past five to six years, only about 25% of adolescents and young adults are using CGM, according to data from the T1D Exchange Clinic Registry of individuals with Type 1 diabetes.
CGMs can help children and their families monitor glucose levels in real time, alerting them to a possible need for treatment adjustments.
Two studies, presented at the American Diabetes Association’s (ADA) 79th Scientific Sessions® at the Moscone Convention Center in San Francisco, this past weekend, looked at the use of CGMs in pediatric and young adult populations.
The SENCE Study
In the first study, Strategies to Enhance New Continuous Glucose Monitoring Use in Early Childhood (SENCE) researchers conducted a six-month study to assess if CGM use by itself or coupled with a family behavioral intervention (FBI) increased the number of time children with T1D maintained blood sugar levels in range, as recommended by ADA’s Standards of Medical Care in Diabetes.
The study enrolled 143 children at 14 sites across the U.S. ages 2 to 7 years who had not previously used a CGM to manage their diabetes.
Patients were randomly divided into three study arms—one-third of participants used self-monitoring of blood glucose using a glucose meter with test strips, one-third used CGM, and one-third used CGM and were provided five 30-minute educational FBI sessions.
Sessions were delivered at clinical visits, staggered between one and 19 weeks after CGM started.
At baseline, all participants spent about 40% of their time in a target range of 70-180 mg/dl and about 55% of their time above this range.
After reviewing participants’ time-in-target range across the entire study period, researchers did not find a change or difference among the three groups.
However, the CGM + FBI group improved time-in-range when compared from enrollment to the end of the study, which allowed all five behavioral intervention sessions to be delivered.
What were the Findings?
Using CGM, children spent less time with glucose values less than 70 mg/dl and over 300 mg/dl, had less variable blood sugar levels and experienced fewer severe low blood sugar events.
At the 26-week follow up, the CGM + FBI group reported feeling less burdened by their diabetes care, worrying less about hypoglycemia and had greater satisfaction with diabetes technology use compared to the other two groups.
Children had excellent compliance, with 90% of children wearing CGM more than six days per week at study end.
“While we were surprised our participants’ time-in-target range did not improve with CGM use, we were enthusiastic to see we moved the needle on time spent with low blood sugar, severely low blood sugar events, and very high levels,” says Dr. Linda Anne DiMeglio, professor of pediatrics at Indiana University School of Medicine and assistant director of Clinical and Translational Research at the Wells Center for Pediatric Research.
“We were encouraged to learn with advances in technology and caregiver support, caregivers for very young children with diabetes are able to improve outcomes for their children,” DiMeglio adds. “We hope this data will help inform policies in states where CGMs are not covered by insurers including Medicaid, so children can have access and coverage to CGMs to maintain healthy glucose levels.”
The CITY Study
The second study, CGM Intervention in Teens and Young Adults With Type 1 Diabetes (CITY) evaluated the impact of CGM on diabetes management in adolescents and young adults with T1D with suboptimal glucose levels.
The study enrolled 153 participants ages 14 to 24 with T1D duration 12 months or longer.
They were randomly assigned to either a Dexcom CGM device or self-monitoring of blood glucose. The study’s primary outcome assessment was the participants’ A1C levels after six months.
What were the Findings?
Reductions in hemoglobin A1c and reductions in the amount of time blood glucose values were in a high (hyperglycemia) range and low (hypoglycemia) range were observed.
Approximately 70% of CGM group participants wore the device an average of five or more days per week, with less than 10% no longer using the device at six months.
There were no safety concerns for either treatment group. In addition to the improved glycemic outcomes, patients reported glucose monitoring satisfaction was higher among CGM users compared with those using a blood glucose meter.
“Adolescents and young adults have been shown to have very poor glucose control and often struggle to adhere to the recommendations of health care providers,” says lead study author Dr. Lori M. Laffel, chief of the pediatric, adolescent and young adult section, and senior investigator and head of the section on Clinical, Behavioral and Outcomes Research at Joslin Diabetes Center.
“Results from the CITY study show adolescents and young adults are willing to wear the CGM device and that use of the device improves glucose levels,” Laffel, who is also a professor of pediatrics at Harvard Medical School. “Knowledge from our study may help to increase the number of adolescents and young adults who use CGM and the results may also help pave the way for the successful uptake of future automated insulin delivery systems for this vulnerable group of teens and young adults in need of improved glucose control.”
American Diabetes Association.
- American Diabetes Association. Access to Continuous Glucose Monitors in Pediatric Diabetes Populations Improves Glycemic Control, Reduces Hypoglycemia and Improves Satisfaction with Diabetes Care and Technology Use. (2019, June 10). PR Newswire. Retrieved: https://www.prnewswire.com/news-releases/access-to-continuous-glucose-monitors-in-pediatric-diabetes-populations-improves-glycemic-control-reduces-hypoglycemia-and-improves-satisfaction-with-diabetes-care-and-technology-use-300864401.html