Real-world use of continuous glucose monitoring (CGM) systems improves glycemic control and reduces the frequency of rare and dangerous events in pediatric type 1 diabetes (T1D), according to study results published in Diabetes Care.
Use of CGM has become the standard of care for T1D, particularly in young patients. However, clinical trials of CGM are often too small or too short in duration to assess the effect of CGM on the occurrence of rare events such as severe hypoglycemia or diabetic ketoacidosis (DKA). Using real-world data from the multicenter German-Austrian-Swiss-Luxembourgian Diabetes Prospective Follow-up (DPV) registry, researchers assessed hemoglobin A1c (HbA1c) levels and the frequency of severe hypoglycemia and DKA during the first year of CGM use in patients with T1D <18 years old.
A total of 3553 patients (47% girls) with a median age of 12.1 years were included in the study. Follow-up was performed after the first 6 months following CGM initiation and again at 12 months of use. Real-time CGM was used by 14% of patients and 46% were on intermittently scanned CGM. An additional 39% of patients had no definitive sensor type recorded.
Compared with baseline, HbA1c levels were lower after the first 6 months (7.58% vs 7.47%; P <.0001) and 12 months (7.48%; P <.0001) of CGM use. At both 6 and 12 months, the percentage of patients who achieved HbA1c levels <7.5% was higher compared with baseline (P <.0001 for both).
The percentage of patients who experienced ≥1 episode of DKA was lower at both 6 (P =.0055) and 12 months (P =.0143). The rate of DKA events was also significantly lower during months 6 through 12 (1.1 vs 2.0 events per 100 person-years at baseline; P =.0254). In addition, fewer patients experienced severe hypoglycemia requiring external help at both 6 (P <.0001) and 12 months (P =.0366) of CGM use. There were also significantly fewer incidences of hypoglycemic coma at 6 (P <.0001) and 12 months (P =.0153).
The researchers noted that the observational design of the study represented a limitation and that reporting biases were possible due to the structure of the DPV registry.
“In summary, initiation and regular use of CGM in children and adolescents with T1D was associated with a reduction in DKA and [severe hypoglycemia] and a modest improvement in metabolic control,” the researchers concluded. “Our findings complement the existing evidence on CGM benefits in pediatric T1D.”
Disclosure: Funding for the study was partially provided by Sanofi and Abbott.
Tauschmann M, Hermann JM, Freiberg C, et al. Reduction in diabetic ketoacidosis and severe hypoglycemia in pediatric type 1 diabetes during the first year of continuous glucose monitoring: a multicenter analysis of 3,553 subjects from the DPV registry [published online January 22, 2020]. Diabetes Care. doi: 10.2337/dc19-1358