Children persist best with CGM if started concurrently with insulin pump
medwireNews: Children with type 1 diabetes make more consistent use of continuous glucose monitoring (CGM) if they are given the device when they initiate insulin pump therapy, rather than several months later, show the CGM TIME Trial results.
Margaret Lawson (Children's Hospital of Eastern Ontario, Ottawa, Canada) and co-researchers explain that the trial design “was based on the idea that simultaneous initiation would capitalize on readiness for change that individuals in the process of changing their insulin delivery method would be experiencing, while also reinforcing the concept that CGM is an integral part of pump therapy, as opposed to an optional addition.”
The trial included 159 children aged between 5 and 18 years, with an average age of 11.5 years and average diabetes duration of approximately 3.5 years.
The children were monitored for 6 months after receiving their CGM devices, and there was a decline over time among both the 70 children who were randomly assigned to receive their devices simultaneously with their insulin pump and among the 69 assigned to receive it 6 months later.
However, throughout this whole period average CGM use during each individual month was significantly higher among the simultaneous receipt group than among the delayed receipt group. For example, the average number of hours’ use per 28 days was 564.0 versus 505.1 (difference=62.4) during the first month and 407.9 versus 340.2 (difference=87.8) during the last month.
The researchers note that 60% CGM use would be equivalent to using it for 403.2 hours per 28 days. There was no significant difference in use between the simultaneous and delayed initiation groups among children who routinely used their CGM device for at least this much time; the difference was only apparent in the full cohort including children with lower usage.
“Previous studies have examined barriers to CGM adherence in adolescents, which include body image, loss of freedom, pain, annoyance with alarms, and data overload,” write Lawson and team in Pediatric Diabetes.
They say: “It makes sense that introducing CGM and pump therapy together might decrease the perceived burden of CGM by combining it with the increased flexibility that pump therapy offers to youth.”
The average glycated hemoglobin (HbA1c) level was 8.05% (64.5 mmol/mol) in the simultaneous initiation group at baseline, and this fell to 7.94% (63.0 mmol/mol) during follow-up. By contrast, values in the delayed initiation group rose from 7.72% (60.9 mmol/mol) to 7.94% (63.0 mmol/mol), and the difference in the change over time between the two groups was statistically significant.
However, the researchers cite the “often-observed phenomenon of a temporary drop in HbA1c immediately after pump initiation, with a gradual increase over time,” and caution that for children given simultaneous CMG “we could not separate the pump effect from the CGM effect.”
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