Background: Self-monitoring of blood glucose is an essential tool in the optimal management of childhood and adolescent diabetes. In the last 15 years, an extraordinary development of reliable devices for real-time continuous glucose monitoring (CGM) has taken place. Meanwhile, several trials in adults and children showed that CGM can be associated with improved glycaemic control, significant reduction of hypoglycaemia and better quality of life, particularly in those patients with a high adherence to continuous use.
Objective and hypotheses: Hypoglycaemia fear is one of the leading obstacles to better glycaemic control. Fluctuating blood glucose levels have been shown to be associated with behavioural changes in children with diabetes as frequently reported by their parents. The continuous use of CGM devices, particularly in terms of sensor-augmented pump treatment, can help young patients with diabetes to overcome these challenges, achieve near-glycaemic control and improve their quality of life.
Method: The advantages and limitations of real-time continuous glucose monitoring will be discussed.
Results: While CGM is beneficial in both patients using multiple daily injections and insulin pump users, the latter combination is more effective. Moreover, new generation of pumps are combining a continuous glucose sensor with a mechanism of automatic shut-off in the presence of low glucose values (low glucose suspend (LGS)) or when a hypoglycaemia is predicted within 30 min (predictive low glucose management (PLGM)). The efficacy of the automatic suspension of insulin delivery was evaluated under challenging conditions both in adults (automation to simulate pancreatic insulin response (ASPIRE)) and in children (predictive low glucose management in realtime sensing insulin pump therapy (PILGRIM)) showing a significantly reduced duration and severity of induced hypoglycemia without causing rebound hyperglycemia.
Conclusion: The implementation of real-time sensor in diabetes pump treatment (open loop) has definitively an advantage over episodic real-time on demand and can be helpful to increase the routine use of CGM. However, prerequisites for sustainable use of CGM are detailed knowledge, realistic expectations, high degree of self-control, ability to interact with negative feedback and maybe even early introduction of CGM in the management of diabetes.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology