Background: Hypoglycaemic episodes in patients with Congenital Hyperinsulinism (CHI) are not always detected due to the intermittent measurement of blood glucose concentrations, particularly the asymptomatic episodes. Detecting and treating these episodes is important for prevention of hypoglycaemic brain injury. Although the Continuous Glucose Monitoring System (CGMS) is widely used in adults and children with diabetes, the use in patients with CHI remains limited.
Aim: To determine whether children with CHI can have an effective glycaemic control with the use of CGMS.
Method: 10 patients with CHI, with a mean age of 7.2 years (range 2.1 - 16.07) using a Dexcom G6 real time CGMS (rtCGMS) were included in this retrospective study over 12 weeks. Parental consent to access the data on Dexcom clarity website was obtained. The primary efficacy outcome measured was time in range in normoglycaemia(TIRN), defined as blood glucose (BG) 3.9 to 10 mmol/l. In addition, the number of hypoglycaemia episodes (BG <3.9 mmol/l) per week, time very low (<3.0 mmol/l)) and time in hyperglycaemia (>10.0 mmol/l) were evaluated. All parameters were assessed at four and twelve weeks from insertion of CGMS.
Results: The TIRN of the patients included in this study varied from 63.1 to 98.8% after the first four weeks on CGMS. After 12 weeks of using CGM, 70% of our cohort (7/10) showed improved TIRN by 0.2 -2.8%. Though in 30% of our participants (3/10) TIRN was worse after 12 weeks, two due to increasing hyperglycaemic episodes and one due to hypoglycaemic episodes. Hence, 90% of our patients (9/10) had a smaller number of weekly hypoglycaemic episodes, with only one case of increase. 50% of the participants (5/10) had reduction of time in very low hypoglycaemia, with three remaining unchanged and two patients showing increase. 50% of the patients (5/10) had reduction of time in hyperglycaemia, in one patient there was no change whereas in four patients an increase was noted.
Conclusion: After 12 weeks of use of Dexcom G6 rtCGMS in patients with CHI at our centre, we noticed an improvement of TIRN and a decrease in number of weekly hypoglycaemic episodes. Therefore, CGMS can assist CHI patients and families with more effective glycaemic control. This way, we may avoid hypoglycaemic brain injury and optimize treatment. Further studies are needed to assess the potential of CGMS as a decision-making tool in hypoglycaemia management in the CHI cohort.
22 Sep 2021 - 26 Sep 2021