Continuous glucose monitoring in young children: satisfaction without success?
Continuous glucose monitoring in young children: satisfaction without success?
复制标题
幼儿持续血糖监测：满意却没有成功？
DOI：
10.1089/dia.2012.0196
复制
发表时间：
2012
影响因子：
5.4
通讯作者：
Weinzimer,StuartA
中科院分区：
文献类型：
--
作者：
Weinzimer,StuartA
The introduction of continuous glucose monitoring (CGM) to the diabetes community was initially met with great excitement and optimism. Finally, a noninvasive (or at least minimally invasive) method of monitoring glucose levels! Imagine, accurate and reliable data, available at all times! Not unreasonably, people anticipated a quick end to hyperand hypoglycemia, as it would be a simple thing to adjust insulin doses with this rich set of information available at all times. As CGM devices were actually used, of course, our naiveté was slowly replaced with a more realistic understanding of the benefits and limitations of CGM. The longedfor ‘‘blood glucose replacement’’indication was tantalizingly dangled in front of us, only to be removed when the true accuracy and lag issues were more fully appreciated. The reality of another device needing to be inserted, tended, frequently replaced, and occasionally discontinued because of skin problems somewhat dampened but did not extinguish our enthusiasm for this new and exciting technology. An early pilot study of CGM, conducted in pediatric patients, demonstrated preliminary efficacy in reducing hemoglobin A1c (A1C) levels and improving the percentage of glucose levels within the target range, 1 and the subsequent landmark Juvenile Diabetes Research Foundation (JDRF) CGM trial demonstrated significant benefits of CGM compared with routine self-monitoring of blood glucose levels. 2 However, this study called into question the benefit of CGM in children: the child/adolescent and adolescent/young adult cohorts in the JDRF study did not experience significant A1C lowering. Was it simply a matter of compliance with use?‘‘Adult success’’with CGM in the JDRF trial may have just been a surrogate marker for consistent wearing of the devices, as a secondary analysis of the JDRF data demonstrated significant A1c lowering in all age groups who wore the sensor for at least 6 days/week. 3 The ‘‘hassle’’factors of CGM, more easily tolerated by adults, were identified as significant barriers to continued use in older children and adolescents. 4 The use of CGM in very young children posed an interesting question: would their benefit be limited, as in older children and adolescents, because of hassles and complaints? Or would the presumably greater parental control over diabetes care enable these devices to be used effectively over a near-continuous time period?In this issue of Diabetes Technology and Therapeutics, Frontino et al. 5 describe their experiences with sensor-augmented pump therapy in young children who attended one of three pediatric diabetes clinics in Italy. The authors identified 28 children 7 years of age or younger, already on insulin pump therapy for at least 6 months, who initiated continuous glucose monitoring (with the Dexcom [San Diego, CA] Seven Plus™ sensor), and followed their progress on CGM for an average of 9 months. Overall, they noted very high levels of compliance with sensor wear and generally high reports of parental satisfaction (based on a 1–3 score rating). Specifically, parents reported greatest benefit on reducing fear of hypoglycemia and usefulness of alarms. Glycemic control was on the whole unchanged after the introduction of CGM; although the authors report that the subgroup with the highest baseline A1C did experience a statistically significant 0.9% drop in A1C by the end of the study, it is unclear whether this was a preplanned analysis or how many subjects this subgroup comprised.
