Continuous glucose monitoring in children and young people: Reducing the “hassle factor”

The vast majority of children and young people with diabetes are not meeting their treatment targets owing to suboptimal self-care associated with psychological factors and physiological changes due to puberty. Only 18.5% of children and young people in the 2013/2014 UK National Paediatric Diabetes Audit (NPDA, 2015) achieved optimal diabetes control. New diabetes technologies may offer opportunities for young people to improve their diabetes control, especially given that the “millennium generation” of 14- and 15-year-olds are the most technology-savvy in the UK and that 6-year-olds have a similar “Digital Quotient” to 45-year-olds (Ofcom, 2014). It is therefore hoped that young people would adopt these new technologies easily. In clinical practice, however, this is not always the case.

Real-time continuous glucose monitoring (CGM) provides continuous display of blood glucose levels as well as alerts for impending high or low glucose levels and, therefore, provides opportunities to make adjustments to treatment plans that should help improve glycaemic control. The efficacy of CGM in improving glycaemic control is related to the amount of sensor use. Sadly, a study exploring the effectiveness of CGM in improving diabetes control in children and young people aged between 8 and 24 years showed that they only wore the CGM system 30–50% of the time (where sensor wear of 6 days or more was defined as 100% compliance; Juvenile Diabetes Research Foundation CGM Study Group, 2008). This non-adherence has been blamed on the “hassle factor” of wearing the sensors. This includes, among other factors, frustration from frequent sensor inaccuracies, which lead to annoying false alarms and alerts, and discrepancies between blood glucose readings from glucose meters and interstitial glucose readings from CGM sensors.

In the study of children and young people aged 2–17 years summarised alongside, Lori Laffel compared the performance of two CGM systems: the Dexcom G4 Platinum system (G4P) and the same system with the new Software 505 algorithm (SW505). The sensors were compared in two separate, 7-day studies. Sensor glucose measurements from both the G4P and SW505 were compared with reference glucose measurements using arterialised venous blood and with glucose meter results using finger-prick capillary samples. The study demonstrated that the updated SW505 algorithm was significantly more accurate than the G4P. The mean absolute relative difference (MARD) compared with venous measurements was 17% for G4P versus 10% for SW505 (P<0.001 for comparison).

The level of accuracy for modern CGM systems is better than that of the original finger-prick blood glucose meters that were approved to inform insulin adjustment 35 years ago (Rodbard, 2016). It is hoped that, as sensor accuracy improves, the hassle factor will be reduced, especially if CGM data can be routinely used for adjustment of insulin therapy.

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