ESPE Abstracts

Background: Glucose monitoring is vital in children with persistent hypoglycaemia to reduce the risk of adverse neuro-behavioural outcomes¹. Continuous glucose monitoring (CGM) systems provide real-time glucose levels however; information on its usefulness in monitoring glucose levels in this cohort is limited^{2, 3}.

Objective: To ascertain the effectiveness of CGM and to evaluate parents’ experience of using CGM for monitoring glucose levels in children with hypoglycaemia who do not have diabetes.

Methods: Retrospective analysis of sensor glucose (SG) values from Dexcom G4 CGM with paired finger-prick blood glucose (BG) values was performed to determine the accuracy of CGM. The parent experience of CGM was assessed using a questionnaire.

Results: SG data from 40 children (median age 6 months) with persistent hypoglycaemia (60% Hyperinsulinism) were analysed. The mean difference between 5,650 paired BG and SG values was 0.28 mmol/l. There was a positive correlation between the two methods (r = 0.79). The sensitivity and specificity of CGM to identify severe hypoglycaemia (BG <3.0 mmol/l) were 54.3% (95% CI: 39.0% to 69.1%) and 97.4% (95% CI: 96.9% to 97.8%) respectively. The positive predictive value for detecting severe hypoglycaemia was 16.0% (95% CI: 10.6% to 22.7%) while the negative predictive value was 99.6% (95% CI: 99.3% to 99.7%). Parents (n = 11) reported less anxiety (n = 9), better sleep at night (n = 7) and preferred to use CGM for monitoring (n = 9).

Conclusion: Although the high number of false positive readings precludes the routine use of CGM in the evaluation of hypoglycaemia, it avoids unnecessary BG testing during normoglycaemia. It is an acceptable tool to parents for monitoring their children who are at risk of hypoglycaemia. Newer CGM systems with improved accuracy at lower glucose levels have the potential to further improve monitoring.

References: 1. Menni F, de Lonlay P, Sevin C, Touati G, Peigné C, Barbier V, et al. Neurologic outcomes of 90 neonates and infants with persistent hyperinsulinemic hypoglycemia. Pediatrics. 2001;107(3): 476-9 2. Rayannavar A, Elci OU, Mitteer L, De Leon DD. Continuous Glucose Monitoring Systems: Are They Useful for Evaluating Glycemic Control in Children with Hyperinsulinism? Horm Res Paediatr. 2020: 1-9. 3. Kotzapanagiotou E, Tsotridou E, Volakli E, Dimitriadou M, Chochliourou E, Kalamitsou S, et al. Evaluation of continuous flash glucose monitoring in a pediatric ICU setting. J Clin Monit Comput. 2019: 1-10

Key Words: Hypoglycaemia, continuous glucose monitoring, hyperinsulinism