The efficacy of outpatient monitoring of children and adolescents with type 1 diabetes with regular use of professional continuous glucose monitoring

BACKGROUND: According to research, only 38% of patients reach glycated hemoglobin targets. It is possible to improve the effectiveness of medical care for children with T1D using modern technologies, including continuous glucose monitoring (CGM).

AIMS: To evaluate the effectiveness of outpatient monitoring of children and adolescents with T1D with regular use of professional continuous glucose monitoring.

METHODS: The inclusion criteria: age 8−12 years; T1D at least 1 year; insulin therapy by multiple injections of insulin; inadequate glycemic control of T1D: НbА_1с level of 7.5% and higher and / or children and adolescents with frequent episodes of hypoglycemia (usually 4 times a week) or with a history of severe hypoglycemia; signed informed consent. All patients initially and 12 weeks after inclusion in the study conducted a study of the level of НbА_1с, and also performed CGM for 6 days. Based on the results of CGM, glycemia indicators and daily doses of insulin were recorded, treatment was evaluated and corrected, and recommendations for self-monitoring were made. Glucose monitoring was carried 120−144 hours using the blind method iPro2 (Medtronic, USA).

RESULTS: In all, 99 children aged 8−18 years were included in the study in all centers. The decrease in the level of НbА_1с by the end of the study was 0.72%, while the proportion of patients who reached the target level of НbА_1с (defined as <7.5%) was statistically significantly higher at the end of the study (15.5% and 2%, respectively; p<0.05). During the study, patients showed a trend towards a decrease in the average level and variability of glycemia by the end of the study, however, statistical significance was achieved only in relation to the average level of glycemia (p=0.04). Conducted insulin therapy, determined by the average daily doses of long-acting and short-acting insulin, did not statistically significantly change at the end of the study. The frequency of DKA episodes and severe hypoglycemia did not statistically significantly differ from the initial level.

CONCLUSIONS: For children with poor glycemic control of T1D, the use of professional CGM is effective in terms of glycemic control and a safe method.

diabetes mellitus type 1, adolescent, child, blood glucose, glycemic, metabolic, glucose monitoring

1. Dedov II. Shestakova MV, Peterkova VA, et al. Diabetes mellitus in children and adolescents according to the Federal diabetes registry in the Russian Federation: dynamics of major epidemiological characteristics for 2013−2016. Diabetes mellitus. 2018;20(6):392–402. doi: https://doi.org/10.14341/DM9460.

2. Петеркова В.А., Швабский О.Р., Карпушкина А.В., Витебская А.В. Отчет об основных результатах исследования потребностей пациентов и системы здравоохранения для улучшения качества медико-социальной помощи детям с эндокринными заболеваниями. — М., 2014. — 48 с. [Peterkova VA, Shvabskii OR, Karpushkina AV, Vitebskaia AV. Otchet ob osnovnykh rezul’tatakh issledovaniia potrebnostei patsientov i sistemy zdravookhraneniia dlia uluchsheniia kachestva mediko-sotsial’noi pomoshchi detiam s endokrinnymi zabolevaniiami. Moscow; 2014. 48 р. (In Russ).]

3. Дедов И.И., Петеркова В.А., Кураева Т.Л., Лаптев Д.Н. Инсулиновая помпа. Помощь врачу и пациенту для эффективного управления диабетом. — М., 2014. — 126 с. [Dedov II, Peterkova VA, Kuraeva TL, Laptev DN. Insulinovaia pompa. Pomoshch’ vrachu i patsientu dlia effektivnogo upravleniia diabetom. Moscow; 2014. 126 р. (In Russ).]

4. Chase HP, Roberts MD, Wightman C, et al. Use of the GlucoWatch biographer in children with type 1 diabetes. Pediatrics. 2003;111(4 Pt 1):790–794. doi: https://doi.org/10.1542/peds.111.4.790.

5. Kaufman FR, Gibson LC, Halvorson M, et al. A pilot study of the continuous glucose monitoring system: clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects. Diabetes Care. 2001;24(12):2030–2034. doi: https://doi.org/10.2337/diacare.24.12.2030.

6. Ludvigsson J, Hanas R. Continuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: a controlled crossover study. Pediatrics. 2003;111(5 Pt 1):933–938. doi: https://doi.org/10.1542/peds.111.5.933.

7. Battelino T, Conget I, Olsen B, et al. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia. 2012;55(12):3155–3162. doi: https://doi.org/10.1007/s00125-012-2708-9.

8. El-Laboudi AH, Godsland IF, Johnston DG, Oliver NS. Measures of glycemic variability in type 1 diabetes and the effect of real-time continuous glucose monitoring. Diabetes Technol Ther. 2016;18(12):806–812. doi: https://doi.org/10.1089/dia.2016.0146.

9. Pickup JC, Freeman SC, Sutton AJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ. 2011;343:d3805. doi: https://doi.org/10.1136/bmj.d3805.

10. Phillip M, Danne T, Shalitin S, et al. Use of continuous glucose monitoring in children and adolescents. Pediatr Diabetes. 2012;13(3):215–228. doi: https://doi.org/10.1111/j.1399-5448.2011.00849.x.

11. Лаптев Д.Н. Преимущество помповой инсулинотерапии и систем мониторирования гликемии в реальном времени в отношении снижения частоты эпизодов гипогликемии у детей и подростков с сахарным диабетом 1 типа // Проблемы эндокринологии. — 2014. — Т.60. — №2. — С. 24–30. [Laptev DN. The advantages of insulin pump therapy and real time glucose monitoring systems as the tools for reducing the frequency of hypoglycemic episodes in the children and adolescents with type 1 diabetes mellitus. Problems of endocrinology. 2014;60(2):24–30. (In Russ).] doi: https://doi.org/10.14341/probl201460224-30.

12. DCCT/EDIC Research Group; de Boer IH, Sun W, Cleary PA, et al. Intensive diabetes therapy and glomerular filtration rate in type 1 diabetes. N Engl J Med. 2011;365(25):2366–2376. doi: https://doi.org/10.1056/NEJMoa1111732.

13. Battelino T, Phillip M, Bratina N, et al. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care. 2011;34(4):795–800. doi: https://doi.org/10.2337/dc10-1989.