Background: The use of continuous glucose monitoring has been proven beneficial in improving glucose control. Nevertheless, its use by the patients is still limited with a high discontinuation rate, especially in the pediatric population. Real-life data showed a 30% adherence to treatment after 1 year of use.
Objective and hypotheses: The most likely explanation for the sensor being underutilized is the significant burden related to its use fraught with tension and anxiety. The sensor necessitate continual attention and decision making by patients and caregivers, while some have difficulty responding to the large influx of data. Furthermore, it acts as a constant reminder of them being diabetic, reporting blood glucose levels at all times. The recording of high and low blood glucose may lead to confrontation between parents and their children. Others are frustrated by false alarms caused by sensor inaccuracy and although expected, evidence shows no reduction in fear of hypoglycemia with its use. Use of episodic real-time glucose sensor data on demand may improve patient adherence to sensor use, allowing patients access to data needed for appropriate decision making regarding insulin dosing.
Method: Several studies showed that continuous glucose monitoring had no advantage over frequent blood glucose measurements. Indeed, a recent data from the exchange registry showed that the target HbA1c can be achieved with seven to nine measurements of blood glucose. Others studies showed that for each additional glucose testing the HbA1c is reduced by 0.2%. However, most patients avoid multiple finger sticks due to the accompanied inconvenience. A sensor that only shows glucose levels and trends on demand, when the patient needs the data and is willing to react, will decrease exhaustion related to sensor use, decrease the burden of monitoring diabetes and improve patient compliance and glycemic control. Episodic real-time data on demand would appear to have all the advantages of continuous monitoring while at the same time being much more convenient. Additional advantages of this sensor are the ease of use without the need for calibration, long use duration and no alarms.
Conclusion: Compliance in management of a chronic disease depends largely on the ease of application of treatment measures. As long as the patient is the one that needs to react to the real-time sensor data, some patients will prefer other means of measurement. Glucose data on demand would appear to offer all the advantages of sensor monitoring without the burden and hassle.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology