Real-world studies reporting the impact of continuous glucose monitoring (CGM) in children with Type 1 diabetes (T1D) are limited. In April 2017 CGM became fully subsidised in Australia for children with T1D <21yrs. We report the impact of this in a large population based sample of paediatric diabetes (n=1093). Almost all (99%) children (age < 18yr) with diabetes in Western Australia attend a single paediatric diabetes centre.
Prior to April 2017 6.5% of children were using CGM, 18 months following CGM funding the rate of usage was 76.1%. Mean age of the clinic group was 11.9 yrs with diabetes duration of 4.4 years; demographic and clinical characteristics of those on CGM were similar. Patients attend clinic every 3 mths. Prospective cohort analysis was used to determine change over time of key diabetes outcomes: HbA1c and severe hypoglycaemia (coma/ convulsions).
The mean HbA1c (± SE) of all T1D (n=1093) for the 6 mths prior to CGM rollout was 8.2±0.05 %. Mean HbA1c of the whole clinic reduced significantly at every 3 mth period up until 18 mths post rollout. At 18 mths, 75% of patients in the clinic were using CGM and mean HbA1c was 7.76±0.06% (P< 0.001 vs baseline). There was a 27 % reduction on severe hypoglycaemic events (3.1 to 2.25 SH/ 100 patient years).
Patients on insulin pump therapy had an HbA1c of 8.16% prior to commencing CGM therapy and at 3 mths post CGM start this has reduced to 7.92% (P=0.002). Patients on subcutaneous injection therapy had an HbA1c of 8.33% prior to starting CGM and HbA1c of 8.14% post (P=0.226).
These data suggest that in a population-based cohort of paediatric patients with T1D the introduction of CGM results in improved glycaemic control and reduced hypoglycaemia over 18 months. These real world data show similar outcomes to randomised controlled trials with CGM and add to the evidence for CGM use in clinical practice for all children with Type 1 diabetes.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology