A Pilot Study of the Continuous Glucose Monitoring System Clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects

OBJECTIVE —To determine whether the continuous glucose monitoring system (CGMS) (MiniMed, Sylmar, CA) could be used to make clinical decisions and whether it has an impact on glycemia in pediatric type 1 diabetic subjects. RESEARCH DESIGN AND METHODS —Pediatric subjects were recruited if they had HbA 1c >8.0% with management problems ( n = 35) or episodes of severe or nocturnal hypoglycemia or hypoglycemia unawareness associated with HbA 1c ≤8.0% ( n = 12). A total of 47 patients with a mean HbA 1c value of 8.6 ± 1.6% (mean age 11.8 ± 4.6 years, youngest 2.7 years, and diabetes duration 5.5 ± 3.5 years) on three to four insulin injections/day ( n = 24) or insulin pump therapy ( n = 23) were followed with the CGMS for a mean of 69.5 ± 28 h. Comparisons were made between the number of high (>150 mg/dl) and low ( 1c levels were evaluated. RESULTS —In patients on injection therapy, 30 high or low glucose patterns were discerned with the logbook records and 120 patterns with the CGMS. Specific alterations of the diabetes regimen were made. An overall significant change in HbA 1c , from 3 months before wearing the sensor to 6 months after (analysis of variance 0.04), was found in the subjects. Post hoc analysis showed a significant change in HbA 1c from 8.6 ± 1.5% at baseline to 8.4 ± 1.3% at 3 months (paired Student’s t test 0.03). CONCLUSIONS —The CGMS can be used by pediatric patients to detect abnormal patterns of glycemia. The information that was obtained could be used to alter the diabetes regimen and impact glycemic outcome.