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Licensed Unlicensed Requires Authentication Published by De Gruyter September 15, 2021

The utility of continuous glucose monitoring systems in the management of children with persistent hypoglycaemia

Sathyakala Vijayanand ORCID logo, Paul G. Stevenson, Maree Grant, Catherine S. Choong, Elizabeth A. Davis and Mary B. Abraham



Glucose monitoring is vital in children with persistent hypoglycaemia to reduce the risk of adverse neuro-behavioural outcomes; especially in children with hyperinsulinism. The role of continuous glucose monitoring (CGM) systems in monitoring glucose levels in this cohort is limited. The objective of this study was to ascertain the effectiveness of CGM and to evaluate parents’ experience of using CGM for monitoring glucose levels in children with hypoglycaemia.


Retrospective analysis of sensor glucose (SG) values from Dexcom G4 CGM with paired finger-prick blood glucose (BG) values was performed to determine the accuracy of CGM. The parent experience of CGM was assessed using a questionnaire administered to families of children with congenital hyperinsulinism currently attending the clinic.


SG data from 40 children (median age 6 months) with persistent hypoglycaemia (60% Hyperinsulinism) were analysed. The mean difference between 5,650 paired BG and SG values was 0.28 mmol/L. The sensitivity and specificity of CGM to identify severe hypoglycaemia (BG < 3.0 mmol/L) were 54.3% (95% CI: 39.0%, 69.1%) and 97.4% (95% CI: 96.9%, 97.8%) respectively. Parents (n=11) reported less anxiety (n=9), better sleep at night (n=7) and preferred to use CGM for monitoring (n=9).


Although the high number of false-positive readings precludes the routine use of CGM in the evaluation of hypoglycaemia, it avoids unnecessary BG testing during normoglycaemia. It is an acceptable tool for parents for monitoring their children who are at risk of hypoglycaemia. Newer CGM systems with improved accuracy at lower glucose levels have the potential to further improve monitoring.

Corresponding author: Mary B. Abraham, Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; and The University of Western Australia, Perth, Western Australia, Australia, E-mail:

Funding source: Department of Health/Raine Clinical Research


M.B.A was supported by the Department of Health/Raine Clinical Research Fellowship from Western Australia.

  1. Research funding: None.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: Ours is a retrospective study which did not require an ethics approval. We registered our project with GEKO (Governance, Evidence, Knowledge, Outcomes) committee of Child and Adolescent Health Services. Approval number: 35064.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2021-06-18
Accepted: 2021-09-02
Published Online: 2021-09-15
Published in Print: 2021-12-20

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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