medwireNews: Data from the DPV cohort show a reduced risk for severe hypoglycemia and diabetic ketoacidosis (DKA) among children and young people with type 1 diabetes using continuous glucose monitoring (CGM) rather than self-monitored blood glucose.
The findings are in line with previous research showing a reduced risk for acute complications in adult users of flash glucose monitoring.
The analysis included 32,117 young people with type 1 diabetes who were older than 18 months but younger than 25 years (median 16.8 years) treated at 412 centers across Austria, Germany, Luxembourg, and Switzerland.
During the most recent treatment year, the rate of severe hypoglycemia was 6.74 per 100 patient–years in the 10,883 young people using CGM, which was significantly lower than the rate of 8.84 per 100 patient–years in the 21,234 who were self-monitoring their blood glucose.
Likewise, the rates per 100 patient–years were 1.01 versus 1.96 for hypoglycemic coma, 3.72 versus 7.29 for diabetic ketoacidosis, and 0.44 versus 0.93 for severe ketoacidosis, with all differences being statistically significant.
As reported in The Lancet Diabetes & Endocrinology, Beate Karges (RWTH Aachen University, Germany) and co-researchers then looked at the relationship between acute complications and CGM metrics.
They found that the risk for severe hypoglycemia was significantly associated with the amount of time young people spent below the recommended blood glucose range (3.9–10.0 mmol/L; 70–180 mg/dL). For example, the incidence rate ratio was 2.38 for 8% or more time versus less than 4%.
And multiple metrics were associated with DKA risk, namely average sensor glucose, time in target glucose range, time above the target range, and glucose variability. For example, the incidence rate ratio was 8.51 for less than 25% of time in range versus at least 70%.
The authors of a linked editorial – Alfonso Galderisi and Jennifer Sherr, both from Yale University in New Haven, Connecticut, USA – note that CGM is already guideline-recommended for young people but stress that “the findings from this study clearly strengthen the evidence base given that this technology can help to mitigate risk of acute diabetes complications.”
They say that “there is compelling evidence supporting the use of CGM in all children and adolescents with type 1 diabetes and that thresholds can be identified to target those at highest risk of acute complications.
“Similar to use of CGM from the time of diabetes diagnosis, remote data viewing of those with established disease might help clinicians to prioritise follow-up and optimise treatment plans or encourage integration of more advanced diabetes technologies for day-to-day management.”
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