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The Positives and Negatives for Continuous Glucose Monitoring in Young Children

Oct 17, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Nour Salhab, Pharm.D. Candidate, USF College of Pharmacy

CGM use in young children with type 1 diabetes has its benefits and challenges, according to their parents.  

Type 1 diabetes management in children (1 to <8 years old) can be challenging. Insulin needs are not easily identified because of their unpredictable behavior, growth spurts, and frequent illnesses. Additional challenges include erratic fluctuations of glucose levels, smaller insulin dosing, and resisting frequent fingersticks to check for glucose levels. Often, it is difficult for parents and their children to know when a hypoglycemia episode occurs because of children being unable to communicate internal sensations and symptoms of hypoglycemia. This creates limitations on leaving children in daycare or with a babysitter. Continuous glucose monitoring reduces the need for frequent fingersticks, provides audible and vibrating alerts to indicate a need for intervention, and provides continuous monitoring of blood glucose levels. Previous studies have established that CGM lowers HbA1c levels only in older children, adolescents, and adults with type 1 diabetes. This study wanted to highlight recent experiences by parents of young children who have used CGM, to pave the way for future studies.   

This trial was performed in four pediatric diabetes care centers in the United States. Eligibility included parents who could speak and read English, being the primary caregiver for a child (aged 1 to <8 years old) with type 1 diabetes (HbA1c <10.5%), and a duration of ≥6 months. Invitations to parents were mailed, followed by a follow-up by mail, telephone, or clinic approach. Semi-structured qualitative interviews were administered to 79 parents. Questions included the parent’s experience with blood glucose meters, insulin pumps, and CGMs. Each device’s perceived benefits and challenges were assessed, along with reasons for stopping/pausing the machine and reasons for not using specific tools. There were 55 parents whose child was currently using CGM and 8 of those who had used CGM previously. The majority of parents self-identified as non-Hispanic Caucasians with a mean child age of 5 +/- 1.5 years, mean diabetes duration of 2.4 +/- 1.3 years, and a mean HbA1c of 7.9% +/- 0.9%. The study used qualitative data analysis to assess for benefits and barriers of CGM use.   

As provided by parents, benefits of CGM use included decreased worry, increased confidence about their childrens safety, improved sleep, helped to identify hypoglycemic and hyperglycemic episodes, provided comfort in leaving their children in daycare and with other caregivers or babysitters, decreased the need for frequent fingersticks, and provided a predictable pattern of blood glucose throughout the day. The parents’ challenges included painful insertion of the sensor, skin irritation from the sensor/adhesive, an overwhelming amount of data, alert fatigue, technical difficulties, inaccuracy if not placed correctly, and difficulty placing the sensor on small children or extremely active ones. There was a possibility of using older generations of CGM with those parents who had problems with it.   

As with everything we utilize in the medical field, each has its benefits and challenges. This study wanted to identify the themes in young children with type 1 diabetes regarding CGM. The study’s strength was the careful assessment of parents’ perceptions focusing on physical, emotional, and technical challenges with the CGM. A limitation of the study was the lack of generalization because most participants were non-Hispanic Caucasian parents. Future studies should include a more diverse population with a higher HbA1c. This trial served to gather qualitative data to assist in an ongoing trial comparing standard type 1 diabetes care without CGM to CGM with primary education plus a family behavioral intervention to support CGM use in families of children under age 8 with type 1 diabetes (ClinicalTrials.gov Identifier: NCT02912728).  

Practice Pearls:  

  • Managing type 1 diabetes in younger children with CGM can provide a sense of security and confidence.  
  • It is essential to keep in mind those extremely active and small children regarding placing the CGM.  
  • These patients must receive the most up-todate CGM to account for insertion ease, improvements in performance, and less frequent sensor changes.    

 

Hilliard, Marisa E., et al. Benefits and Barriers of Continuous Glucose Monitoring in Young Children with Type 1 Diabetes. Diabetes Technology & Therapeutics, Sept. 2019  

 

Nour Salhab, Pharm.D. Candidate, USF College of Pharmacy 

 

See more about treating children with diabetes in our Pediatrics center.