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Continuous Glucose Monitoring in Children and Adolescents

Abstract

Continuing glucose monitoring (CGM) is a relatively new and rapidly developing technology that shows promise for the future management of type 1 diabetes. When used with near-daily frequency, it has a significant effect on improvement of glucose metabolism as measured by HbA1C and reduction of hypoglycemia. It appears to be safe and actually reduces both DKA and severe hypoglycemia. Early studies indicate that it should be cost effective.

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References

  1. Diabetes Control and Complication Trial Research Group. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  2. Chase HP, Beck R, Tamborlane W, et al. Randomized multicenter trial comparing the GlucoWatch Biographer with standard glucose monitoring in children with type 1 diabetes. Diabetes Care. 2005;28:1101–6.

    PubMed  Article  Google Scholar 

  3. Phillip M, Danne T, Shalitin S, et al. Consensus Statement: use of continuous glucose monitoring in children and adolescents. Pediatr Diabetes. 2012;13:215–28.

    PubMed  Article  CAS  Google Scholar 

  4. Hirsch IB, Abelseth J, Bode BW, et al. Sensor-augmented insulin pump therapy: results of the first randomized treat-to-target study. Diab Technol Ther. 2008;10:377–83.

    Article  CAS  Google Scholar 

  5. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring in youth with type 1 diabetes: 12-month follow up of the JDRF continuous glucose monitoring randomized trial. Diabetes Technol Ther. 2010;12:507–15.

    Article  Google Scholar 

  6. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care. 2009;32:1378–83.

    Article  Google Scholar 

  7. Raccah D, Sulmont V, Reznik Y, et al. Incremental value of continuous glucose monitoring when starting pump therapy in patients with poorly controlled type 1 diabetes. Diabetes Care. 2009;32:2245–50.

    PubMed  Article  CAS  Google Scholar 

  8. Kordonouri O, Pankowska E, Rami B, et al. Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment. Diabetologia. 2010;53:2487–95.

    PubMed  Article  CAS  Google Scholar 

  9. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Effectiveness of continuous glucose monitoring in a clinical care environment. Diabetes Care. 2010;33:17–22.

    Article  Google Scholar 

  10. Bergenstal RM, Tamborlane WV, Ahmann A, et al. For the STAR 3 Study Group. Effectiveness of sensor-augmented insulin pump therapy in type 1 diabetes. N Engl J Med. 2010;363:311–20.

    PubMed  Article  CAS  Google Scholar 

  11. Slover RH, Welsh JB, Criego A, et al. Effectiveness of sensor-augmented pump therapy in children and adolescents with type 1 diabetes in the STAR 3 study. Pediatric Diabetes. 2012;13:6–11.

    PubMed  Article  CAS  Google Scholar 

  12. Buckingham B, Beck RW, Tamborlane WV, et al. Diabetes Research in Children Network (DirecNet) Study Group: continuous glucose monitoring in children with type 1 diabetes. J Pediatr. 2007;151:388–93.

    PubMed  Article  Google Scholar 

  13. Beck RW, Buckingham B, Miller K, et al. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Factors predictive of use and of benefit from continuous glucose monitoring in type 1 diabetes. Diabetes Care. 2009;32:1947–53.

    PubMed  Article  Google Scholar 

  14. Diess D, Bolinder J, Riveline JP, et al. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care. 2006;29:2730–2.

    Article  Google Scholar 

  15. O’Connell MA, Donath S, O'Neal DN, et al. Glycaemic impact of patient-led use of sensor-guided pump therapy in type 1 diabetes: a randomized controlled trial. Diabetologia. 2009;52:1250–7.

    PubMed  Article  Google Scholar 

  16. Buckingham B, Block J, Burdick J, et al. Response to nocturnal alarms using a real-time glucose sensor. Diabetes Technol Ther. 2005;7:440–7.

    PubMed  Article  CAS  Google Scholar 

  17. Garg S, Zisser H, Schwartz S, et al. Improvement in glycemic excursions with a tanscutaneous, real-time continuous glucose sensor. Diabetes Care. 2006;29:44–50.

    PubMed  Article  CAS  Google Scholar 

  18. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359:1464–76.

    Article  Google Scholar 

  19. Battelino T, Phillip M, Bratina N, et al. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care. 2011;34:1–6.

    Article  Google Scholar 

  20. Ly TT, Lim EM, Hewitt J, et al. Improving epinephrine responses in hypoglycemia unawareness with real-time continuous glucose monitoring adolescents with type 1 diabetes. Diabetes Care. 2011;34:50–2.

    PubMed  Article  Google Scholar 

  21. Garg S, Jovanovic L. Relationship of fasting and hourly glucose back to HbA1C. Diabetic Care. 2006;29:2644–9.

    Article  Google Scholar 

  22. Rodhard D, Jovanovic L, et al. Regimen to continuous glucose monitoring in subjects with type 1 diabetes using continuous subcutaneous insulin infusion multiple daily injections. Diab Technol Ther. 2009;11:757–65.

    Article  Google Scholar 

  23. Danne T, Valk HW, et al. Reducing glycemic variability in type 1 diabetes self management with a continuous glucose monitoring system based on Wired Enzyme technology. Diabetologia. 2009;52:1496–503.

    PubMed  Article  CAS  Google Scholar 

  24. Garg SK, Crew SB, Maser EG, et al. Effect of continuous monitoring on glycemic control in subjects with type 1 diabetes (T1D) delivering insulin via pump or multiple daily injections (MDI): a perspective study. Diabetes. 2010;59:A33.

    Article  Google Scholar 

  25. Gottlieb PA, Crew, Maser EG, et al. Effect of continuous glucose monitoring on glycaemic control in subjects with type 1 diabetes delivering insulin via pump or multiple daily injections: a perspective study. Diabetologia. 2010;53:525.

    Article  Google Scholar 

  26. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359:1–13.

    Article  Google Scholar 

  27. 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;24:2030–4.

    PubMed  Article  CAS  Google Scholar 

  28. Ludvigsson J, Hanas R. Continuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: a controlled crossover study. Pediatrics. 2003;111:933–8.

    PubMed  Article  Google Scholar 

  29. Golicki DT, Golicka D, Groele L, Pankowska E. Continuous glucose monitoring system in children with type 1 diabetes mellitus: a systematic review and meta-analysis. Diabetologia. 2008;51:233–40.

    PubMed  Article  CAS  Google Scholar 

  30. Diess D, Hartmann R, Schmidt J, et al. Results of a randomized controlled cross-over trial on the effect of continuous subcutaneous glucose monitoring (CGMS) on glycaemic control in children and adolescents with type 1 diabetes. Exp Clin Endocrinol Diabetes. 2006;114:63–7.

    Article  Google Scholar 

  31. Yates K, Hasnat Milton A, Dear K, Ambler G. Continuous glucose monitoring-guided insulin adjustment in children and adolescents on near-physiological insulin regimens: a randomized controlled trial. Diabetes Care. 2006;29:1512–7.

    PubMed  Article  CAS  Google Scholar 

  32. Lagarde WH, Barrows FP, Davenport ML, et al. Continuous subcutaneous glucose monitoring in children with type 1 diabetes mellitus: a single-blind, randomized, controlled trial. Pediatr Diabetes. 2006;7:159–64.

    PubMed  Article  Google Scholar 

  33. Chase HP, Kim LM, Owen SL, et al. Continuous glucose monitoring in children with type 1 diabetes. Pediatrics. 2001;107:222–6.

    PubMed  Article  CAS  Google Scholar 

  34. Blevins TC, Bode BW, Garg SK, et al. AACE Continuous Glucose Monitoring Task Force, Rothermel C. Statement by the American Association of Clinical Endocrinologists Consensus Panel on continuous glucose monitoring. Endocr Pract. 2010;16:730–45.

    PubMed  Google Scholar 

  35. Svoren B, Svoren BM, Volkening LK, et al. Temporal trends in the treatment of pediatric type 1 diabetes and impact on acute outcomes. J Pediatr. 2007;150:279–85.

    PubMed  Article  Google Scholar 

  36. Rewers A, Chase HP. Predictors of acute complications in children with type 1 diabetes. JAMA. 2002;287:2511–8.

    PubMed  Article  Google Scholar 

  37. Buckingham B, Block J, Burdick J, et al. Diabetes Research in Children Network: response to nocturnal alarms using a real-time glucose sensor. Diabetes Technol Ther. 2005;7:440–7.

    PubMed  Article  CAS  Google Scholar 

  38. Chase HP, Roberts MD, Wightman C, et al. Use of the glucowatch biographer in children with type 1 diabetes. Pediatrics. 2003;111:790–4.

    PubMed  Article  Google Scholar 

  39. Chase HP, Beck RW, Xing D, et al. Continuous glucose monitoring in youth with type 1 diabetes: 12-month follow-up of the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Randomized Trial. Diabetes Technol Ther. 2010;12:507–15.

    PubMed  Article  CAS  Google Scholar 

  40. Tansey M, Laffel L, Cheng J, et al. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Satisfaction with continuous glucose monitoring in adults and youths with type 1 diabetes. Diabetic Med. 2011;9:1118–22.

    Article  Google Scholar 

  41. Buckingham B, Xing D, Weinzimer S, et al. Diabetes Research In Children Network (DirecNet) Study Group. Use of the DirecNet Applied Treatment Algorithm (DATA) for diabetes management with a real-time continuous glucose monitor (the FreeStyle Navigator). Pediatr Diabetes. 2008;9:142–7.

    PubMed  Article  Google Scholar 

  42. Messer L, Ruedy K, Dongyuan X, et al. Diabetes Research in Children Network (DirectNet) Study Group. Educating families on real time continuous glucose monitoring: the DirectNet Navigator pilot study experience. Diabetes Educ. 2009;35:124–35.

    PubMed  Article  Google Scholar 

  43. Beck RW, Lawrence JM, Laffel L, et al. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Quality-of-life measures in children and adults with type 1 diabetes: Juvenile Diabetes Research Foundation Continuous Glucose Monitoring randomized trial. Diabetes Care. 2010;33:2175–7. [Epub 2010 Aug 9]: Erratum in: Diabetes Care. 2010;33:725.

    PubMed  Article  Google Scholar 

  44. Wysocki T, Cheng J, Beck RW, et al. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Validation of measures of satisfaction with, and impact of continuous and conventional glucose monitoring. Diabetes Technol Ther. 2010;12:679–84.

    Article  Google Scholar 

  45. Ritholz M. Is continuous glucose monitoring for everyone? Consideration of psychosocial factors. Diabetes Spectr. 2008;21:287–9.

    Article  Google Scholar 

  46. Tansey M, Laffel L, Cheng J, et al. Satisfaction with continuous glucose monitoring in adults and youth with type 1 diabetes. Diabet Med. 2011;28:1118–22.

    PubMed  Article  CAS  Google Scholar 

  47. Huang ES, O’Grady M, Basu A, et al. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group: the cost-effectiveness of continuous glucose monitoring in type 1 diabetes. Diabetes Care. 2010;33:1269–74.

    PubMed  Article  Google Scholar 

  48. Holzinger U, Warszawska J, Kitzberger R, et al. Real-time continuous glucose monitoring in critically ill patients. Diabetes Care. 2010;33:467–72.

    PubMed  Article  CAS  Google Scholar 

  49. Brunner R, Kitzberger R, Miehsler W, et al. Accuracy and reliability of a subcutaneous continuous glucose-monitoring system in crucially ill patients. Crit Care Med. 2011;39:659–64.

    PubMed  Article  Google Scholar 

  50. Jefferies C, Solomon M, Perlman K, et al. Continuous glucose monitoring in adolescents with cystic fibrosis. J Pediatr. 2005;147:396–8.

    PubMed  Article  Google Scholar 

  51. O'Riordan S, Hoey H, George S, et al. Can continuous glucose monitoring (CGMS) enhance the detection of CFRD in 167 cystic fibrosis children? Diabetes Care. 2006;72:A17.

    Google Scholar 

  52. O’Riordan S, Roche E, George S, et al. Continuous glucose monitoring enhances the detection of cystic fibrosis related diabetes in children with cystic fibrosis. Diabetologia. 2007;50(Suppl 1)OP 32, 0190:S1–538.

    Google Scholar 

  53. O'Riordan SM, Hindmarsh P, Hill NR, et al. Validation of continuous glucose monitoring in children and adolescents with cystic fibrosis: a prospective cohort study. Diabetes Care. 2009;32:1020–2.

    PubMed  Article  Google Scholar 

  54. Meade LT. The use of continuous glucose monitoring in patients with type 2 diabetes. Diabetes Technol Ther. 2012;14:190–5.

    PubMed  Article  Google Scholar 

  55. Boland E, Monsod T, Delucia M, et al. Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes. Diabetes Care. 2001;24:1858–62.

    PubMed  Article  CAS  Google Scholar 

  56. Weinzimer S, Xing D, Tansey M, et al. Diabetes Research in Children Network Study Group: prolonged use of continuous glucose monitors in children with type 1 diabetes on continuous subcutaneous insulin infusion or intensive multiple-daily injection therapy. Pediatr Diabetes. 2009;10:91–6.

    PubMed  Article  CAS  Google Scholar 

  57. Gandrud LM, Xing D, Kollman C, et al. The Medtronic Minimed Gold continuous glucose monitoring system: an effective means to discover hypo- and hyperglycemia in children under 7 years of age. Diabetes Technol Ther. 2007;9:307–16.

    PubMed  Article  CAS  Google Scholar 

  58. Jeha GS, Karaviti LP, Anderson B, et al. Continuous glucose monitoring and the reality of metabolic control in preschool children with type 1 diabetes. Diabetes Care. 2004;27:2881–6.

    PubMed  Article  Google Scholar 

  59. Weinzimer S, Xing D, Tansey M, et al. Diabetes Research in Children Network (DirecNet) Study Group. FreeStyle navigator continuous glucose monitoring system use in children with type 1 diabetes using glargine-based multiple daily dose regimens: results of a pilot trial Diabetes Research in Children Network (DirecNet) Study Group. Diabetes Care. 2008;31:525–7.

    PubMed  Article  Google Scholar 

  60. Kaufman FR, Austin J, Neinstein A, et al. Nocturnal hypoglycemia detected with the continuous glucose monitoring system in pediatric patients with type 1 diabetes. J Pediatr. 2002;141:625–30.

    PubMed  Article  CAS  Google Scholar 

  61. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Prolonged nocturnal hypoglycemia is common during 12 months of continuous glucose monitoring in children and adults with type 1 diabetes. Diabetes Care. 2010;33:1004–8.

    Article  Google Scholar 

  62. Buckingham B, Chase HP, Dassau E, et al. Prevention of nocturnal hypoglycemia using predictive alarm algorithms and insulin pump suspension. Diabetes Care. 2010;33:1013–7.

    PubMed  Article  Google Scholar 

  63. Schaepelynck-Belicar P, Vague P, Simonin G, et al. Improved metabolic control in diabetic adolescents using the continuous glucose monitoring system (CGMS). Diabetes Metab. 2003;29:608–12.

    PubMed  Article  CAS  Google Scholar 

  64. Bode BW, Steed RD, Schleusener DS, et al. Switch to multiple daily injections with insulin glargine and insulin lispro from continuous subcutaneous insulin infusion with insulin lispro: a randomized, open-label study using a continuous glucose monitoring system. Endocr Pract. 2005;11:157–64.

    PubMed  Google Scholar 

  65. Diess D, Hartmann R, Hoeffe J, et al. Assessment of glycemic control by continuous glucose monitoring system in 50 children with type 1 diabetes starting on insulin pump therapy. Pediatr Diabetes. 2004;5:117–21.

    Article  Google Scholar 

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Acknowledgments

R.H. Slover II has received the following grants:

(1) NIH U01 HD041890 / Effect of Metabolic Control at Onset of Diabetes on Progression of Type 1 Diabetes. 05/01/2009–10/31/2014.

(2) Medtronic/An In-clinic, Randomized, Cross-Over Study to Assess the Efficacy of the Low Glucose Suspend (LGS) Feature in the MiniMed Paradigm X54 System with Hypoglycemic Induction from Exercise. 05/01/2010–04/30/2013.

(3) Juvenile Diabetes Research Foundation (JDRF)/22-2011-639 Treat-to-Range Closed-Loop Therapy for Type 1 Diabetes: SMART Rx 09/01/2011–08/31/2013.

Disclosure

R.H. Slover II has received research support from Medtronic, a company that manufactures the device.

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Correspondence to Robert Henry Slover II.

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Slover, R.H. Continuous Glucose Monitoring in Children and Adolescents. Curr Diab Rep 12, 510–516 (2012). https://doi.org/10.1007/s11892-012-0303-6

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  • DOI: https://doi.org/10.1007/s11892-012-0303-6

Keywords

  • Diabetes
  • Continuous glucose monitoring
  • Monitoring
  • Children
  • Adolescents