Trial demonstrates some benefits of CGM in young children with type 1 diabetes
medwireNews: The use of continuous glucose monitoring (CGM) does not increase time in range in young children with type 1 diabetes, but may improve other glycemic indices, researchers report.
“Recent evidence indicates that […] the overwhelming majority of young children with type 1 diabetes currently have suboptimal glycemic control,” say Kellee Miller (Jaeb Center for Health Research, Tampa, Florida, USA) and colleagues.
They explain that burdens associated with sleep disruption, data overload, and the desire to avoid hypoglycemia “created barriers to effective CGM use” in this population, but “[r]ecent improvements in CGM wearability and performance characteristics may have reduced these barriers.”
For the trial, 143 children aged 2–7 years with type 1 diabetes were randomly assigned to receive CGM with a Dexcom G5 Mobile system, either with or without a family behavioral intervention (FBI) for their caregivers, or to carry out traditional finger-stick blood glucose monitoring without CGM.
Miller and team say that adherence to the intervention was “high,” with approximately 90% of participants in the CGM groups wearing the device on at least 6 days per week.
The primary outcome of time spent in the target range of 70–180 mg/dL (3.9–10.0 mmol/L) was comparable among children in the CGM plus FBI, CGM alone, and control groups, at an average of 42%, 41%, and 40%, respectively.
However, CGM use “was associated with significant improvements in three critical glycemic indices,” report the investigators. Specifically, children in the CGM plus FBI and CGM alone groups spent a significantly lower proportion of time in hypoglycemia (<70 mg/dL) than those in the control group, at an average of 2.6% and 2.5% versus 5.8%, respectively, at 6 months. There were also fewer severe hypoglycemic events during the study period in the CGM groups (none and one vs five, respectively), as well as less glucose variability.
These findings suggest “that caregivers likely used CGM to focus on avoiding hypoglycemia rather than on reducing hyperglycemia or increasing glucose time in range,” write Miller et al in Diabetes Care.
They note that the behavioral intervention for caregivers “resulted in additional benefits beyond the reductions in hypoglycemia.” For instance, caregivers from the CGM plus FBI group had lower diabetes distress scores and less fear of hypoglycemia than those in the CGM alone and control arms.
The researchers conclude: “Future studies should explore interventions that assist families in more effectively using CGM, likely in combination with other advanced diabetes technologies, to improve glycemic management for young children.”
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