Description
Managing diabetes in children requires tools that balance effective glucose control with a child’s active lifestyle. Continuous Glucose Monitoring (CGM) provides real-time insights, helping parents and healthcare teams respond quickly to fluctuations. Insulin pumps offer flexibility and precision, reducing the burden of multiple daily injections. Emerging closed-loop systems, also known as “artificial pancreas,” integrate CGM with insulin delivery to automatically adjust dosing, improving safety and quality of life. These technologies empower children and families to better manage diabetes, minimize complications, and focus on growth and development while ensuring tighter, safer glucose control.
Summary Listen
- Different methods exist for plasma glucose monitoring, including self-monitoring, HbA1c testing, and continuous glucose monitoring (CGM). While HbA1c is a reliable marker for overall glucose control, it has limitations such as inaccuracy in certain conditions, inability to detect hypoglycemia, and failure to capture glucose variability.
- Glycemic variability, which includes both short-term and long-term fluctuations in blood glucose levels, has significant implications for health. Short-term variability can increase the risk of hypoglycemia and oxidative stress, while long-term variability contributes to endothelial dysfunction and microvascular complications.
- CGM systems measure interstitial glucose levels continuously using a sensor, transmitter, and receiver. These systems, including flash and real-time CGMs, provide valuable data on glucose trends and patterns. Flash CGMs require manual scanning, while real-time CGMs offer automatic readings and alarms.
- Time in Range (TIR), the percentage of time glucose levels are within the target range (70-180 mg/dL), is a crucial metric for assessing glycemic control. A higher TIR is associated with lower HbA1c levels and a reduced risk of long-term complications. Achieving a TIR of >70% correlates with an HbA1c < 7%.
- Blinded CGMs are used for retrospective analysis by healthcare professionals, while flash CGMs provide on-demand readings and real-time CGMs offer continuous monitoring and alerts. Real-time CGMs can transmit data to the cloud for remote monitoring and require calibration with fingerstick blood glucose.
- CGMs provide ambulatory glucose profiles showing glucose levels over a 24-hour period, identifying areas of hyperglycemia, hypoglycemia, and time within the target range. This data facilitates the development of personalized diabetes management plans.
- Objective measures like Time Above Range (TAR) and Time Below Range (TBR) provide further insight. CGM data minimizes bias and provides a complete glucose experience, including excess glucose exposure, hypoglycemia episodes, and glucose variability. Frequent scanning with CGMs and understanding trend arrows help to avoid recurrent hospital admissions due to hypoglycemia or DKA.
- Accuracy of CGMs is assessed using Mean Absolute Relative Difference (MARD), with lower MARD values indicating better accuracy. Certain over-the-counter drugs can affect CGM accuracy and should be considered.
- Insulin delivery systems include I-Ports, smart insulin pens, and insulin pumps. I-Ports offer a single injection port for multiple insulin doses, while smart pens track insulin data and provide personalized recommendations.
- Insulin pumps deliver insulin continuously and offer multiple basal rate settings, bolus options, and features like auto-suspend. They are indicated for those with recurrent hypoglycemia, glucose variability, suboptimal control, or those with lifestyle restrictions.
- Insulin pump therapy offers advantages such as reduced hypoglycemia and blood glucose variability, but it also comes with cost concerns and the risk of DKA upon discontinuation. Temporary basal rates, food boluses, and correction boluses can be programmed for flexible insulin delivery.
- Advanced insulin delivery systems include sensor-augmented pumps, low glucose suspend systems, predictive low glucose suspend systems, and closed-loop systems (automated insulin delivery). Closed-loop systems, like the Medtronic 780G, use an algorithm to automatically adjust insulin delivery based on CGM readings.
- Future advancements include dual hormone systems using insulin and glucagon, as well as pramlintide, an amylin analog, to improve postprandial glucose control. The ultimate goal is personalized care with the safest, most affordable and appropriate insulin delivery technology.
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About the Speakers
Dr. Dhanya Soodhana
Senior Specialist, Pediatric and Adolescent Endocrinology, Aster MIMS, Calicut, Kerala
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