CGM valuable in young diabetes patients
Continuous glucose monitors (CGMs) are valuable tools for controlling type 1 diabetes among children and young adults, as well as for improving patient satisfaction with diabetes care, according to two studies presented in a joint symposium at the recently concluded 79th Scientific Sessions of the American Diabetes Association at the Moscone Convention Centre in San Francisco.
“Knowledge from our study may help increase the number of adolescents and young adults who use CGM, and the results may also help pave the way for the successful uptake of future automated insulin delivery systems for this vulnerable group of teens and young adults in need of improved glucose control,” according to Dr Lori Laffel, lead author of the CITY study (CGM intervention in teens and young adults with type 1 diabetes).
Randomly assigning 153 adolescents (aged 14–24 years) to either use CGM device or to self-monitor blood glucose levels, CITY found significant reductions in blood glucose concentrations after 6 months of observations. A similar effect was also reported for the duration of time participants spent in hyperglycaemia and hypoglycaemia. [Laffel L, et al, American Diabetes Association 2019]
Participants were also more satisfied with CGM devices as opposed to blood glucose monitors.
Notably, the CITY team reported high device uptake and adherence, and low attrition overall. For instance, 70 percent of all enrolled adolescents wore the device for an average of at least 5 days a week, while less than 10 percent stopped CGM use by the 6-month follow-up.
“Adolescents and young adults have been shown to have very poor glucose control and often struggle to adhere to the recommendations of healthcare providers,” Laffel said. “Results from the CITY study show adolescents and young adults are willing to wear the CGM device and that use of the device improves glucose levels.”
Primary results of the SENCE trial (strategies to enhance new CGM use in early childhood), the second study presented at the ADA symposium, showed that family involvement may further boost the acceptability and efficacy of CGMs.
SENCE assigned 143 children to one of three study arms: self-monitor of blood glucose, CGM use or CGM use in conjunction with 30-minute educational family behavioural intervention (FBI) sessions.
The FBI add-on improved time-in-range relative to baseline, as well as reduced the time children spent above or below the optimal blood glucose range. Those who received CGM with FBI likewise reported greater satisfaction with diabetes technology and less burdened by disease management. [DiMeglio L, American Diabetes Association 2019]
However, the SENCE team pointed out that by the end of the study period, there was no significant difference in time-in-range among the three study arms.
“While we were surprised [that] our participants’ time-in-target range did not improve with CGM use, we were enthusiastic to see we moved the needle on time spent with low blood sugar, severe low blood sugar events and very high levels,” said Dr Linda DiMeglio, assistant director of the Clinical and Translational Research at the Wells Centre for Paediatric Research.
“We hope this data will help inform policies in states where CGMs are not covered by insurers including Medicaid, so children can have access and coverage to CGMs to maintain healthy glucose levels,” she added.