Journal
JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM
Volume 34, Issue 12, Pages 1567-1572Publisher
WALTER DE GRUYTER GMBH
DOI: 10.1515/jpem-2021-0414
Keywords
continuous glucose monitoring; hyperinsulin-ism; hypoglycaemia
Categories
Funding
- Department of Health/Raine Clinical Research Fellowship from Western Australia
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This study evaluated the effectiveness of continuous glucose monitoring in children with hypoglycemia, particularly in those with hyperinsulinism. Results showed that CGM had high accuracy in detecting severe hypoglycemia, but had a high number of false-positive readings at lower glucose levels. Parents reported less anxiety, better sleep, and a preference for using CGM for monitoring their at-risk children. Newer CGM systems with improved accuracy at lower glucose levels could further enhance monitoring in the future.
Objectives: Glucose monitoring is vital in children with persistent hypoglycaemia to reduce the risk of adverse neuro-behavioural outcomes; especially in children with hyperinsulinism. The role of continuous glucose monitoring (CGM) systems in monitoring glucose levels in this cohort is limited. The objective of this study was to ascertain the effectiveness of CGM and to evaluate parents' experience of using CGM for monitoring glucose levels in children with hypoglycaemia. Methods: Retrospective analysis of sensor glucose (SG) values from Dexcom G4 CGM with paired finger-prick blood glucose (BG) values was performed to determine the accuracy of CGM. The parent experience of CGM was assessed using a questionnaire administered to families of children with congenital hyperinsulinism currently attending the clinic. Results: SG data from 40 children (median age 6 months) with persistent hypoglycaemia (60% Hyperinsulinism) were analysed. The mean difference between 5,650 paired BG and SG values was 0.28 mmol/L. The sensitivity and specificity of CGM to identify severe hypoglycaemia (BG < 3.0 mmol/L) were 54.3% (95% CI: 39.0%, 69.1%) and 97.4% (95% CI: 96.9%, 97.8%) respectively. Parents (n=11) reported less anxiety (n=9), better sleep at night (n=7) and preferred to use CGM for monitoring (n=9). Conclusions: Although the high number of false-positive readings precludes the routine use of CGM in the evaluation of hypoglycaemia, it avoids unnecessary BG testing during normoglycaemia. It is an acceptable tool for parents for monitoring their children who are at risk of hypoglycaemia. Newer CGM systems with improved accuracy at lower glucose levels have the potential to further improve monitoring.
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