Feasibility of prolonged continuous glucose monitoring in toddlers with type 1 diabetes

Abstract

Objective: To examine the feasibility of continuous glucose monitoring (CGM) use in very young children with type 1 diabetes (T1D).

Research design and methods: Twenty-three children less than 4 yr of age with T1D were provided with a FreeStyle Navigator(®) (n = 21) or a Paradigm(®) (n = 2) CGM device. At baseline, mean age was 3.0 ± 0.8 yr, mean hemoglobin A1c (HbA1c) was 8.0 ± 0.8%, 10 were using an insulin pump and 13 were on multiple daily injections. CGM use was evaluated over a 6-month period.

Results: Three children dropped out of the study before the end of 6 months. Among the 20 children who completed 6 months of follow-up, CGM use in month 6 was ≥6 d/wk in 9 (45%), 4 ≤ 6 d/wk in 2 (10%), and <4 d/wk in 9 (45%). Skin reactions were minimal. Although there was no detectable change in mean HbA1c between baseline and 6 months (7.9 and 8.0%, respectively), there was a high degree of parental satisfaction with CGM as measured on the CGM satisfaction scale questionnaire. A high percentage of glucose values were in the hyperglycemic range, and biochemical hypoglycemia was infrequent.

Conclusion: More than 40% of very young children were able to safely use CGM on a near-daily basis after 6 months. CGM demonstrated frequent hyperglycemic excursions, with a large variability in glucose readings. Although improvement in glycemic control was not detected in the group as a whole, parental satisfaction with CGM was high.

© 2011 John Wiley & Sons A/S.

Figures

Figure 1. CGM Usage during the Study

(limited to children who completed the 26 week visit, N=20) CGM was considered to be used on a day when there was at least one sensor glucose value.

Figure 2. Glycemic Indices throughout the study (N=20

% of values ≤70mg/dL (A), % of values in the target range 71–180 mg/dL (B), % of values >250 mg/dL (C) and CV (D). The bottom and top of each box represent the 25th and 75th percentile, respectively. The horizontal line inside the box represents the median and the dot represents the mean.