Realtime Continuous Glucose Monitoring in Children and Adolescents— An Overview of the Current Technology and its Impact on Patient Outcomes

2012 ◽  
Vol 08 (01) ◽  
pp. 30
Author(s):  
Jeniece Trast ◽  
Neesha Ramchandani ◽  
◽  
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Patient Outcomes ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Age Groups ◽  
Glucose Monitoring ◽  
Parental Satisfaction ◽  
Patient Use

Continuous glucose monitoring (CGM) systems, available for patient use since 1999, and realtime continuous glucose monitoring (RT-CGM) systems, available since 2006, have helped optimize diabetes management. Previously, RT-CGM studies found benefits mainly in patients with type 1 diabetes over the age of 25. Children and adolescents often present a challenge when managing type 1 diabetes. However, it is now apparent that RT-CGM has clear benefits in these age groups as well as in adults. Not only have studies shown improvements in glycemic control in this population, they have also demonstrated parental satisfaction with the technology. Challenges with RT-CGM use still exist and must be addressed. Nevertheless, RT-CGM is a beneficial tool to assist in diabetes management, and its use should be encouraged in the majority of pediatric patients with type 1 diabetes.

scholarly journals Functional data analysis and prediction tools for continuous glucose-monitoring studies

2020 ◽  
pp. 1-10
Author(s):  
Emrah Gecili ◽  
Rui Huang ◽  
Jane C. Khoury ◽  
Eileen King ◽  
Mekibib Altaye ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Functional Data ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Patient Specific ◽  
Prediction Errors ◽  
Medical Monitoring

Abstract Introduction: To identify phenotypes of type 1 diabetes based on glucose curves from continuous glucose-monitoring (CGM) using functional data (FD) analysis to account for longitudinal glucose patterns. We present a reliable prediction model that can accurately predict glycemic levels based on past data collected from the CGM sensor and real-time risk of hypo-/hyperglycemic for individuals with type 1 diabetes. Methods: A longitudinal cohort study of 443 type 1 diabetes patients with CGM data from a completed trial. The FD analysis approach, sparse functional principal components (FPCs) analysis was used to identify phenotypes of type 1 diabetes glycemic variation. We employed a nonstationary stochastic linear mixed-effects model (LME) that accommodates between-patient and within-patient heterogeneity to predict glycemic levels and real-time risk of hypo-/hyperglycemic by creating specific target functions for these excursions. Results: The majority of the variation (73%) in glucose trajectories was explained by the first two FPCs. Higher order variation in the CGM profiles occurred during weeknights, although variation was higher on weekends. The model has low prediction errors and yields accurate predictions for both glucose levels and real-time risk of glycemic excursions. Conclusions: By identifying these distinct longitudinal patterns as phenotypes, interventions can be targeted to optimize type 1 diabetes management for subgroups at the highest risk for compromised long-term outcomes such as cardiac disease or stroke. Further, the estimated change/variability in an individual’s glucose trajectory can be used to establish clinically meaningful and patient-specific thresholds that, when coupled with probabilistic predictive inference, provide a useful medical-monitoring tool.

scholarly journals Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes Mellitus

2020 ◽  
pp. 193229682091889 ◽  
Author(s):  
Rachel S. Rigo ◽  
Laura E. Levin ◽  
Donald V. Belsito ◽  
Maria C. Garzon ◽  
Rachelle Gandica ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Diabetes Management ◽  
Demographic Data ◽  
Glucose Monitoring ◽  
Subcutaneous Insulin ◽  
Cutaneous Reactions

Background: Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are the standard of care for type 1 diabetes in children. There is little reported on device-related skin complications and treatment options. This study documents cutaneous reactions to CGM and CSII devices in children and young adults with type 1 diabetes. Methods: One hundred and twenty-one subjects (3-25 years) with type 1 diabetes and CGM and/or CSII use were recruited over a three-month period from the Naomi Berrie Diabetes Center at Columbia University Irving Medical Center. A five-question survey was completed for each subject detailing demographic data, diabetes management, and device-related skin complications. Results: Sixty percent of subjects reported skin complications related to CGM and/or CSII use. Terms most frequently used to describe cutaneous reactions were “red,” “itchy,” “painful,” and “rash.” Subjects who used both CGM and CSII were more likely to report skin problems than those who used only CSII (odds ratio 2.9, [95% confidence interval: 1.2-6.7]; P = .015). There were no associations between skin complications and sex or race/ethnicity. Twenty-two percent of subjects with adverse skin event(s) discontinued use of a device due to their skin problem. Seven percent were evaluated by a dermatologist. Eighty-one percent used a range of products to treat their symptoms, with variable perceived clinical outcomes. Conclusions: Skin complications related to CSII or CGM devices are commonly reported in pediatric patients with type 1 diabetes and may lead to interruption or discontinuation of device use. Future studies are needed to elucidate the causes of these reactions and determine the best methods for prevention.

scholarly journals Technology for Augmenting Type 1 Diabetes Mellitus Management

2019 ◽  
Vol 24 (2) ◽  
pp. 99-106
Author(s):  
Michelle Condren ◽  
Samie Sabet ◽  
Laura J. Chalmers ◽  
Taylor Saley ◽  
Jenna Hopwood
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Delivery ◽  
Diabetes Mellitus Management

Type 1 diabetes mellitus has witnessed significant progress in its management over the past several decades. This review highlights technologic advancements in type 1 diabetes management. Continuous glucose monitoring systems are now available at various functionality and cost levels, addressing diverse patient needs, including a recently US Food and Drug Administration (FDA)–approved implantable continuous glucose monitoring system (CGMS). Another dimension to these state-of-the-art technologies is CGMS and insulin pump integration. These integrations have allowed for CGMS-based adjustments to basal insulin delivery rates and suspension of insulin delivery when a low blood glucose event is predicted. This review also includes a brief discussion of upcoming technologies such as patch-based CGMS and insulin-glucagon dual-hormonal delivery.

scholarly journals Recommendations for Using Real-Time Continuous Glucose Monitoring (rtCGM) Data for Insulin Adjustments in Type 1 Diabetes

2016 ◽  
Vol 11 (1) ◽  
pp. 138-147 ◽  
Author(s):  
Jeremy Pettus ◽  
Steven V. Edelman
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Rate Of Change ◽  
Clinical Experiences ◽  
Clinical Benefits ◽  
Effective Use ◽  
Patient Use

The clinical benefits of real time continuous glucose monitoring (rtCGM) use have been well demonstrated in both CSII- and MDI-treated individuals in large clinical trials. However, recommendations for patient use of rtCGM in everyday life situations are lacking. This article provides guidance to clinicians and patients with type 1 diabetes (T1D) in effective use of rtCGM data, including glucose rate of change (ROC) arrows, for insulin dosing adjustments and other treatment decisions. The recommendations presented here are based on our own clinical experiences as endocrinologists, our personal experiences living with T1D using rtCGM, and findings from a recent survey of T1D patients who have successfully used rtCGM in their self-management. It is important that both clinicians and people with diabetes understand the utility and limitations of rtCGM. Maintaining a collaborative clinician-user relationship remains an important factor in safe, successful rtCGM use.

Significance of “Time below Range” as a Glycemic Marker Derived from Continuous Glucose Monitoring in Japanese Children and Adolescents with Type 1 Diabetes

2020 ◽  
Vol 93 (4) ◽  
pp. 251-257
Author(s):  
Tatsuhiko Urakami ◽  
Kei Yoshida ◽  
Remi Kuwabara ◽  
Yusuke Mine ◽  
Masako Aoki ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Target Range ◽  
Japanese Children ◽  
Mean Frequency ◽  
The Mean

<b><i>Introduction:</i></b> We evaluated the frequencies of various glycemic markers derived from continuous glucose monitoring in Japanese children and adolescents with type 1 diabetes and assessed the significance of hypoglycemia duration. <b><i>Methods:</i></b> We enrolled 85 children and adolescents (36 boys and 49 girls) with type 1 diabetes who used FreeStyle<sup>®</sup> Libre in the present study. Frequencies of blood glucose levels as time within target range (TIR; 70–180 mg/dL), time below target range (TBR; &#x3c;70 mg/dL), time below extreme hypoglycemia range (TBER; &#x3c;54 mg/dL), and time above range (TAR; &#x3e;180 mg/dL) were assessed during a 3-month study period. Furthermore, we evaluated the intraday frequencies of TBR and TBER. <b><i>Results:</i></b> The mean frequencies of TIR, TBR, and TAR were 52.7 ± 11.3%, 10.8 ± 5.4%, and 36.5 ± 10.8%, respectively, whereas the mean frequency of TBER was 1.1 ± 0.9% (0–3.0%); there was no clinical episode of severe hypoglycemia. The mean frequency of TBR was significantly greater in 0–6 h (16.9 ± 5.2%) than in 6–12 h (7.8 ± 2.9%) and 18–24 h (6.8 ± 4.8%; <i>p</i> &#x3c; 0.01) time zones, respectively. <b><i>Discussion/Conclusion:</i></b> We found similar TIR and comparatively higher TBR frequencies, particularly during sleep, than those that were previously reported. Possible reasons for the higher frequency of TBR include differences in the quality of insulin treatment and diabetes care between the present study and the European studies. The utilization of advanced technologies, such as a predictive low-glucose suspend-function pump or closed-loop therapy, can reduce the frequency of TBR, with a consequent increase in TIR frequency and comprehensive improvement in glycemic control.

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