The role of continuous glucose monitoring in the care of children with type 1 diabetes

International Journal of Pediatric Endocrinology

Jordan E Pinsker¹  Noelle S Larson¹ 

[1] Department of Pediatrics, Division of Pediatric Endocrinology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA

关键词: Type 1 diabetes;    Diabetes;    Continuous glucose monitoring;    Children;    Adolescents;   

Others  :  812591
DOI  :  10.1186/1687-9856-2013-8

 received in 2013-03-15, accepted in 2013-03-20,  发布年份 2013

【 摘 要 】

Continuous glucose monitoring (CGM), while a relatively new technology, has the potential to transform care for children with type 1 diabetes. Some, but not all studies, have shown that CGM can significantly improve hemoglobin A1c levels and reduce time spent in the hypoglycemic range in children, particularly when used as part of sensor-augmented pump (SAP) therapy. Despite the publication of recent clinical practice guidelines suggesting CGM be offered to all children 8 years of age or older who are likely to benefit, and studies showing that younger children can also benefit, this technology is not yet commonly used by children with type 1 diabetes. Effects of CGM are enhanced when used on a near-daily basis (a use-dependent effect) and with insulin pump therapy. Therefore, coordinated strategies are needed to help children and their families initiate and continue to use this resource for diabetes care. This review introduces CGM to pediatric endocrinologists who are not yet familiar with the finer details of this technology, summarizes current data showing the benefits and limitations of CGM use in children, reviews specific case examples demonstrating when CGM can be helpful, and shows the value of both retrospective and real-time CGM. It is hoped that this information leads to discussion of this technology in pediatric endocrinology clinics as an important next step in improving the care of children with type 1 diabetes.

【 授权许可】

   
2013 Larson and Pinsker; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

【 参考文献 】

• [1]Klonoff DC, Buckingham B, Christiansen JS, Montori VM, Tamborlane WV, Vigersky RA, Wolpert H: Continuous glucose monitoring: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011, 96:2968-2979.
• [2]Phillip M, Danne T, Shalitin S, Buckingham B, Laffel L, Tamborlane W, Battelino T: Use of continuous glucose monitoring in children and adolescents (*). Pediatr Diabetes 2012, 13:215-228.
• [3]Hirsch IB: Clinical review: Realistic expectations and practical use of continuous glucose monitoring for the endocrinologist. J Clin Endocrinol Metab 2009, 94:2232-2238.
• [4]Rigla M: Smart telemedicine support for continuous glucose monitoring: the embryo of a future global agent for diabetes care. J Diabetes Sci Technol 2011, 5:63-67.
• [5]Heinemann L, Franc S, Phillip M, Battelino T, Ampudia-Blasco F, Bolinder J, Diem P, Pickup J, Hans DeVries J: Reimbursement for continuous glucose monitoring: a European view. J Diabetes Sci Technol 2012, 6:1498-1502.
• [6]Ellis SL, Naik RG, Gemperline K, Garg SK: Use of continuous glucose monitoring in patients with type 1 diabetes. Curr Diabetes Rev 2008, 4:207-217.
• [7]Cemeroglu AP, Stone R, Kleis L, Racine MS, Postellon DC, Wood MA: Use of a real-time continuous glucose monitoring system in children and young adults on insulin pump therapy: patients’ and caregivers’ perception of benefit. Pediatr Diabetes 2010, 11:182-187.
• [8]Raccah D, Sulmont V, Reznik Y, Guerci B, Renard E, Hanaire H, Jeandidier N, Nicolino M: Incremental value of continuous glucose monitoring when starting pump therapy in patients with poorly controlled type 1 diabetes: the RealTrend study. Diabetes Care 2009, 32:2245-2250.
• [9]Francescato MP, Geat M, Stel G, Cauci S: Accuracy of a portable glucose meter and of a Continuous Glucose Monitoring device used at home by patients with type 1 diabetes. Clin Chim Acta 2012, 413:312-318.
• [10]Gandrud LM, Xing D, Kollman C, Block JM, Kunselman B, Wilson DM, Buckingham BA: The Medtronic Minimed Gold continuous glucose monitoring system: an effective means to discover hypo- and hyperglycemia in children under 7 years of age. Diabetes Technol Ther 2007, 9:307-316.
• [11]Schiaffini R, Ciampalini P, Fierabracci A, Spera S, Borrelli P, Bottazzo GF, Crino A: The Continuous Glucose Monitoring System (CGMS) in type 1 diabetic children is the way to reduce hypoglycemic risk. Diabetes Metab Res Rev 2002, 18:324-329.
• [12]Maia FF, Araujo LR: Efficacy of continuous glucose monitoring system (CGMS) to detect postprandial hyperglycemia and unrecognized hypoglycemia in type 1 diabetic patients. Diabetes Res Clin Pract 2007, 75:30-34.
• [13]Ives B, Sikes K, Urban A, Stephenson K, Tamborlane WV: Practical aspects of real-time continuous glucose monitors: the experience of the Yale Children’s Diabetes Program. Diabetes Educ 2010, 36:53-62.
• [14]Zijlstra E, Heise T, Nosek L, Heinemann L, Heckermann S: Continuous glucose monitoring: quality of hypoglycaemia detection. Diabetes Obes Metab 2013, 15:130-135.
• [15]Leelarathna L, Nodale M, Allen JM, Elleri D, Kumareswaran K, Haidar A, Caldwell K, Wilinska ME, Acerini CL, Evans ML: Evaluating the accuracy and large inaccuracy of two continuous glucose monitoring systems. Diabetes Technol Ther 2013, 15:143-149.
• [16]Damiano ER, El-Khatib FH, Zheng H, Nathan DM, Russell SJ: A comparative effectiveness analysis of three continuous glucose monitors. Diabetes Care 2013, 36:251-259.
• [17]Keenan DB, Mastrototaro JJ, Zisser H, Cooper KA, Raghavendhar G, Lee SW, Yusi J, Bailey TS, Brazg RL, Shah RV: Accuracy of the Enlite 6-day glucose sensor with guardian and Veo calibration algorithms. Diabetes Technol Ther 2012, 14:225-231.
• [18]DexCom G4: Dexcom G4 PLATINUM User’s Guide. San Diego, CA; 2012. http://www.dexcom.com/sites/dexcom.com/files/dexcom-g4/docs/dexcomG4-UsersGuide-English-mmol24hr.pdf webcite
• [19]Golicki DT, Golicka D, Groele L, Pankowska E: Continuous Glucose Monitoring System in children with type 1 diabetes mellitus: a systematic review and meta-analysis. Diabetologia 2008, 51:233-240.
• [20]Chetty VT, Almulla A, Odueyungbo A, Thabane L: The effect of continuous subcutaneous glucose monitoring (CGMS) versus intermittent whole blood finger-stick glucose monitoring (SBGM) on hemoglobin A1c (HBA1c) levels in Type I diabetic patients: a systematic review. Diabetes Res Clin Pract 2008, 81:79-87.
• [21]Beck RW, Buckingham B, Miller K, Wolpert H, Xing D, Block JM, Chase HP, Hirsch I, Kollman C, Laffel L: Factors predictive of use and of benefit from continuous glucose monitoring in type 1 diabetes. Diabetes Care 2009, 32:1947-1953.
• [22]Beck RW, Hirsch IB, Laffel L, Tamborlane WV, Bode BW, Buckingham B, Chase P, Clemons R, Fiallo-Scharer R, Fox LA: The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care 2009, 32:1378-1383.
• [23]Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J: Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care 2011, 34:795-800.
• [24]Kordonouri O, Pankowska E, Rami B, Kapellen T, Coutant R, Hartmann R, Lange K, Knip M, Danne T: Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment. Diabetologia 2010, 53:2487-2495.
• [25]Slover RH, Welsh JB, Criego A, Weinzimer SA, Willi SM, Wood MA, Tamborlane WV: Effectiveness of sensor-augmented pump therapy in children and adolescents with type 1 diabetes in the STAR 3 study. Pediatr Diabetes 2012, 13:6-11.
• [26]Scaramuzza AE, Iafusco D, Rabbone I, Bonfanti R, Lombardo F, Schiaffini R, Buono P, Toni S, Cherubini V, Zuccotti GV: Use of integrated real-time continuous glucose monitoring/insulin pump system in children and adolescents with type 1 diabetes: a 3-year follow-up study. Diabetes Technol Ther 2011, 13:99-103.
• [27]Frontino G, Bonfanti R, Scaramuzza A, Rabbone I, Meschi F, Rigamonti A, Battaglino R, Favalli V, Bonura C, Sicignano S: Sensor-augmented pump therapy in very young children with type 1 diabetes: an efficacy and feasibility observational study. Diabetes Technol Ther 2012, 14:762-764.
• [28]Battelino T, Conget I, Olsen B, Schutz-Fuhrmann I, Hommel E, Hoogma R, Schierloh U, Sulli N, Bolinder J: The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia 2012, 55:3155-3162.
• [29]Lehecka KE, Renukuntla VS, Heptulla RA: Insight into hypoglycemia in pediatric type 1 diabetes mellitus. Int J Pediatr Endocrinol 2012, 2012:19. BioMed Central Full Text
• [30]Wiltshire EJ, Newton K, McTavish L: Unrecognised hypoglycaemia in children and adolescents with type 1 diabetes using the continuous glucose monitoring system: prevalence and contributors. J Paediatr Child Health 2006, 42:758-763.
• [31]Hermanides J, DeVries JH: Sense and nonsense in sensors. Diabetologia 2010, 53:593-596.
• [32]Hirsch IB, Abelseth J, Bode BW, Fischer JS, Kaufman FR, Mastrototaro J, Parkin CG, Wolpert HA, Buckingham BA: Sensor-augmented insulin pump therapy: results of the first randomized treat-to-target study. Diabetes Technol Ther 2008, 10:377-383.
• [33]Ly TT, Nicholas JA, Retterath A, Davis EA, Jones TW: Analysis of glucose responses to automated insulin suspension with sensor-augmented pump therapy. Diabetes Care 2012, 35:1462-1465.
• [34]Agrawal P, Welsh JB, Kannard B, Askari S, Yang Q, Kaufman FR: Usage and effectiveness of the low glucose suspend feature of the Medtronic Paradigm Veo insulin pump. J Diabetes Sci Technol 2011, 5:1137-1141.
• [35]Cauza E, Hanusch-Enserer U, Strasser B, Ludvik B, Kostner K, Dunky A, Haber P: Continuous glucose monitoring in diabetic long distance runners. Int J Sports Med 2005, 26:774-780.
• [36]Riddell MC, Milliken J: Preventing exercise-induced hypoglycemia in type 1 diabetes using real-time continuous glucose monitoring and a new carbohydrate intake algorithm: an observational field study. Diabetes Technol Ther 2011, 13:819-825.
• [37]Garg S, Brazg RL, Bailey TS, Buckingham BA, Slover RH, Klonoff DC, Shin J, Welsh JB, Kaufman FR: Reduction in duration of hypoglycemia by automatic suspension of insulin delivery: the in-clinic ASPIRE study. Diabetes Technol Ther 2012, 14:205-209.
• [38]Heinemann L: The diabetes technologist: a practical solution in dealing with technology in everyday practice? J Diabetes Sci Technol 2012, 6:1240-1241.
• [39]CDTC Credential Program. http://clinicaldiabetestechnology.org/index.shtml webcite
• [40]Cengiz E, Sherr JL, Weinzimer SA, Tamborlane WV: New-generation diabetes management: glucose sensor-augmented insulin pump therapy. Expert Rev Med Devices 2011, 8:449-458.
• [41]Weinzimer S, Xing D, Tansey M, Fiallo-Scharer R, Mauras N, Wysocki T, Beck R, Tamborlane W, Ruedy K: Prolonged use of continuous glucose monitors in children with type 1 diabetes on continuous subcutaneous insulin infusion or intensive multiple-daily injection therapy. Pediatr Diabetes 2009, 10:91-96.
• [42]Gilliam LK, Hirsch IB: Practical aspects of real-time continuous glucose monitoring. Diabetes Technol Ther 2009, 11(Suppl 1):S75-82.
• [43]Chase HP: Understanding insulin pumps & continuous glucose monitors. 2nd Ed. edition. Childrens Diabetes Foundation: Denver, CO; 2010.
• [44]Buckingham B, Xing D, Weinzimer S, Fiallo-Scharer R, Kollman C, Mauras N, Tsalikian E, Tamborlane W, Wysocki T, Ruedy K, Beck R: Use of the DirecNet Applied Treatment Algorithm (DATA) for diabetes management with a real-time continuous glucose monitor (the FreeStyle Navigator). Pediatr Diabetes 2008, 9:142-147.
• [45]Orzeck EA: Maximizing reimbursement through correct coding initiatives. Diabetes Technol Ther 2009, 11(Suppl 1):S121-127.
• [46]DeVries JH: Continuous glucose monitoring: coming of age? Eur J Endocrinol 2012, 166:1-4.
• [47]Wadwa RP, Fiallo-Scharer R, Vanderwel B, Messer LH, Cobry E, Chase HP: Continuous glucose monitoring in youth with type 1 diabetes. Diabetes Technol Ther 2009, 11(Suppl 1):S83-91.
• [48]Mauras N, Beck R, Xing D, Ruedy K, Buckingham B, Tansey M, White NH, Weinzimer SA, Tamborlane W, Kollman C: 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, 35:204-210.
• [49]Pinsker JE, Nguyen C, Young S, Fredericks GJ, Chan D: A pilot project for improving paediatric diabetes outcomes using a website: the Pediatric Diabetes Education Portal. J Telemed Telecare 2011, 17:226-230.
• [50]Marling CR, Shubrook JH, Vernier SJ, Wiley MT, Schwartz FL: Characterizing blood glucose variability using new metrics with continuous glucose monitoring data. J Diabetes Sci Technol 2011, 5:871-878.