Endocrine Abstracts

Introduction: Optimal glycaemic control can be extremely challenging to achieve in children and adolescents with Type 1 Diabetes (T1D) who have labile glycaemic control with frequent hypoglycaemia despite intensive blood glucose monitoring (BGM). Effectiveness of continuous glucose monitoring (CGM) in children/adolescents at high risk of hypoglycaemia has been poorly studied. Frequent patient follow-up and review is recommended to support successful CGM management. This pilot study explored the impact of CGM and regular clinical review on glycaemic control in children/adolescents with T1D experiencing frequent unpredictable hypoglycaemia.

Methods: Children/adolescents aged 2–18 with T1D (n=10) wore a CGM device for six weeks. During this period, each participant had four clinical reviews with a Paediatric Diabetes Consultant, who assessed the participant’s CGM download, adjusted insulin dosage and offered relevant advice to optimise glycaemic control. Glycaemic outcomes from Week 1 and Week 6 of CGM were compared.

Results: Mean daily glucose was 11.5 mmol/L (SD 1.8) in Week 1 and 9.2 mmol/L (0.8) in Week 6: mean reduction of 2.3 (95% CI −3.4 to −1.3; P=0.002). Weekly SD of glucose levels (as a measure of glycaemic variability) decreased by 1.1 over six weeks (−1.5 to −0.7; P<0.001). Total weekly time spent with a glucose level between 4 and 10 mmol/L increased by 38.25 hours (25.99 to 50.51; P<0.001). This was accompanied by a mean reduction of 8.17 hours in the total weekly time spent with a glucose level <4 mmol/L (−11.2 to −5.13; P<0.001) and 1.42 hours in the total weekly time spent with a glucose level <2.8 mmol/L (−2.23 to −0.59, P=0.004). Additionally, weekly time spent with a glucose level >10 mmol/L decreased by 30.08 hours (−43.61 to −16.54; P=0.001).

Conclusion: CGM with regular clinical review over six weeks significantly improved glycaemic control and reduced hypoglycaemia in children/adolescents with T1D. These are important and meaningful clinical outcomes. Larger and longer studies are required to examine longer term impact of CGM on glycaemic control and avoidance of hypoglycaemia in this vulnerable group. These improvements may also have a positive impact on other outcomes including quality of life and sleep quality.