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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

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

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

Acknowledgements

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.

References

1. Galcheva, S, Al-Khawaga, S, Hussain, K. Diagnosis and management of hyperinsulinaemic hypoglycaemia. Best Pract Res Clin Endocrinol Metabol 2018;32:551–73. https://doi.org/10.1016/j.beem.2018.05.014.Search in Google Scholar PubMed

2. Menni, F, de Lonlay, P, Sevin, C, Touati, G, Peigné, C, Barbier, V, et al.. Neurologic outcomes of 90 neonates and infants with persistent hyperinsulinemic hypoglycemia. Pediatrics 2001;107:476–9. https://doi.org/10.1542/peds.107.3.476.Search in Google Scholar PubMed

3. Ludwig, A, Enke, S, Heindorf, J, Empting, S, Meissner, T, Mohnike, K. Formal neurocognitive testing in 60 patients with congenital hyperinsulinism. Hormone Res Paediatr 2018;89:1–6. https://doi.org/10.1159/000481774.Search in Google Scholar PubMed

4. Lal, RA, Maahs, DM. Clinical use of continuous glucose monitoring in pediatrics. Diabetes Technol Therapeut 2017;19:S37–43. https://doi.org/10.1089/dia.2017.0013.Search in Google Scholar PubMed PubMed Central

5. Cambiaso, P, Schiaffini, R, Pontrelli, G, Carducci, C, Ubertini, G, Crea, F, et al.. Nocturnal hypoglycaemia in ACTH and GH deficient children: role of continuous glucose monitoring. Clin Endocrinol 2013;79:232–7. https://doi.org/10.1111/cen.12123.Search in Google Scholar PubMed

6. Rayannavar, A, Elci, OU, Mitteer, L, De Leon, DD. Continuous glucose monitoring systems: are they useful for evaluating glycemic control in children with hyperinsulinism? Hormone Res Paediatr 2019;92:319–27. https://doi.org/10.1159/000506230.Search in Google Scholar PubMed PubMed Central

7. Hussain, A, Lucy, T, Zoe, Y, Mohammed, D, Senthil, S. Continuous flash glucose monitoring in children with congenital hyperinsulinism first report on accuracy and patient experience. Int J Pediatr Endocrinol 2018;2018:1–6.Search in Google Scholar

8. Conrad, SC, Mastrototaro, JJ, Gitelman, SE. The use of a continuous glucose monitoring system in hypoglycemic disorders. J Pediatr Endocrinol Metab 2004;17. https://doi.org/10.1515/jpem.2004.17.3.281.Search in Google Scholar PubMed

9. Vincent J Carey, TL, Ripley, B. Generalized Estimation Equation Solver, v4.13-20; 2019. Available from: https://CRAN.R-project.org/package=gee.Search in Google Scholar

10. Noujaim, SE, Horwitz, D, Sharma, M, Marhoul, J. Accuracy requirements for a hypoglycemia detector: an analytical model to evaluate the effects of bias, precision, and rate of glucose change. J Diabetes Sci Technol 2007;1:652–68. https://doi.org/10.1177/193229680700100509.Search in Google Scholar PubMed PubMed Central

11. Clarke, W, Jones, T, Rewers, A, Dunger, D, Klingensmith, GJ. Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes 2008;9:165–74. https://doi.org/10.1111/j.1399-5448.2008.00405.x.Search in Google Scholar PubMed

12. Beck, RW. Effectiveness of continuous glucose monitoring in a clinical care environment: evidence from the Juvenile Diabetes Research Foundation continuous glucose monitoring (JDRF-CGM) trial. Diabetes Care 2010;33:17–22. https://doi.org/10.2337/dc09-1502.Search in Google Scholar PubMed PubMed Central

13. Burckhardt, M-A, Roberts, A, Smith, G, Abraham, M, Davis, E, Jones, T. The use of continuous glucose monitoring with remote monitoring improves psychosocial measures in parents of children with type 1 diabetes: a randomized crossover trial. Diabetes Care 2018;41:2641. https://doi.org/10.2337/dc18-0938.Search in Google Scholar PubMed

14. Freckmann, G. Basics and use of continuous glucose monitoring (CGM) in diabetes therapy. J Lab Med 2020;44:71–9. https://doi.org/10.1515/labmed-2019-0189.Search in Google Scholar

15. Laffel, L. Improved accuracy of continuous glucose monitoring systems in pediatric patients with diabetes mellitus: results from two studies. Diabetes Technol Therapeut 2016;18(2 Suppl):S223–33. https://doi.org/10.1089/dia.2015.0380.Search in Google Scholar PubMed PubMed Central

16. Welsh, JB, Gao, P, Derdzinski, M, Puhr, S, Johnson, TK, Walker, TC, et al.. Accuracy, utilization, and effectiveness comparisons of different continuous glucose monitoring systems. Diabetes Technol Therapeut 2019;21:128–32. https://doi.org/10.1089/dia.2018.0374.Search in Google Scholar PubMed PubMed Central

17. Wadwa, RP, Laffel, LM, Shah, VN, Garg, SK. Accuracy of a factory-calibrated, real-time continuous glucose monitoring system during 10 Days of use in youth and adults with diabetes. Diabetes Technol Therapeut 2018;20:395–402. https://doi.org/10.1089/dia.2018.0150.Search in Google Scholar PubMed PubMed Central

18. NDSS. Available from: https://www.ndss.com.au/wp-content/uploads/forms/form-cgm-eligibility-assessment-other-conditions.pdf.Search in Google Scholar


Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpem-2021-0414).


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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