Endocrine Abstracts

Introduction: Currently despite NICE (2004) recommending continuous glucose monitoring (CGM) in the presence of hypoglycaemic unawareness or glucose excursions successful funding applications remain low with only children under 5 years of age being consistently successful within our service. Variability has also been noted as to whether children young people (CYP) and their families use sensors continuously or intermittently. This audit aimed to highlight effectiveness of continuous and intermittent use and any variation across the age ranges, barriers to use and critical feedback for service provision.

Methodology: A one page questionnaire was developed to audit existing users and elicit information regarding frequency, usability, patient experience and effectiveness.

Results: Despite a large cohort of our caseload using Insulin pump therapy (IPT) and CGM (provided by the specialist team) just nineteen children are funded by their PCT for both technologies. Twelve out of 19 CYP were under five years of age at CGM initiation. Fourteen commenced CGM at IPT initiation. This audit identified eight out of nineteen were funded to use sensors continuously and of this group all but one of the patients consistently achieved a HbA1c <7.5%.

Of those that do not wear CGM continuously (n=11) the most frequently cited reasons included:- constant reminder of diabetes, additional demands (psychologically and physically), skin irritation, not accurate enough, nuisance alarms, too large for small kids and discomfort. The benefits included significantly reduced blood glucose testing, feeling more in control, being able to prevent highs and lows, having the confidence not to test and for parents sleeping more soundly.

Conclusion: CGM can incrementally improve diabetes management but improvements in the accuracy and practicalities remain. A CGM workshop with opportunities for interactive learning using increasingly complex scenarios, to facilitate consistent and comprehensive analysis both within clinic consultations and the home setting were also suggested.