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Van Name MA, Kanapka LG, DiMeglio LA, Miller KM, Albanese-O’Neill A, Commissariat P, Corathers SD, Harrington KR, Hilliard ME, Anderson BJ, Kelley JC, Laffel LM, MacLeish SA, Nathan BM, Tamborlane WV, Wadwa RP, Willi SM, Williams KM, Wintergerst KA, Woerner S, Wong JC, DeSalvo DJ. Long-term Continuous Glucose Monitor Use in Very Young Children With Type 1 Diabetes: One-Year Results From the SENCE Study. J Diabetes Sci Technol 2023; 17:976-987. [PMID: 35343269 PMCID: PMC10348002 DOI: 10.1177/19322968221084667] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Achieving optimal glycemic outcomes in young children with type 1 diabetes (T1D) is challenging. This study examined the durability of continuous glucose monitoring (CGM) coupled with a family behavioral intervention (FBI) to improve glycemia. STUDY DESIGN This one-year study included an initial 26-week randomized controlled trial of CGM with FBI (CGM+FBI) and CGM alone (Standard-CGM) compared with blood glucose monitoring (BGM), followed by a 26-week extension phase wherein the BGM Group received the CGM+FBI (BGM-Crossover) and both original CGM groups continued this technology. RESULTS Time in range (70-180 mg/dL) did not improve with CGM use (CGM+FBI: baseline 37%, 52 weeks 41%; Standard-CGM: baseline 41%, 52 weeks 44%; BGM-Crossover: 26 weeks 38%, 52 weeks 40%). All three groups sustained decreases in hypoglycemia (<70 mg/dL) with CGM use (CGM+FBI: baseline 3.4%, 52 weeks 2.0%; Standard-CGM: baseline 4.1%, 52 weeks 2.1%; BGM-Crossover: 26 weeks 4.5%, 52 weeks 1.7%, P-values <.001). Hemoglobin A1c was unchanged with CGM use (CGM+FBI: baseline 8.3%, 52 weeks 8.2%; Standard-CGM: baseline 8.2%, 52 weeks 8.0%; BGM-Crossover: 26 weeks 8.1%, 52 weeks 8.3%). Sensor use remained high (52-week study visit: CGM+FBI 91%, Standard-CGM 92%, BGM-Crossover 88%). CONCLUSION Over 12 months young children with T1D using newer CGM technology sustained reductions in hypoglycemia and, in contrast to prior studies, persistently wore CGM. However, pervasive hyperglycemia remained unmitigated. This indicates an urgent need for further advances in diabetes technology, behavioral support, and diabetes management educational approaches to optimize glycemia in young children.
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Affiliation(s)
| | | | - Linda A. DiMeglio
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Sarah D. Corathers
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | | | | | | | - Lori M. Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | | | | | | | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven M. Willi
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kupper A. Wintergerst
- Wendy Novak Diabetes Center, University of Louisville, Norton Children’s Hospital, Louisville, KY, USA
| | - Stephanie Woerner
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jenise C. Wong
- Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, CA, USA
| | - Daniel J. DeSalvo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
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Miller VA, Xiao R, Willi SM. Correlates of Continuous Glucose Monitoring Use Trajectories in Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:590-594. [PMID: 33605786 PMCID: PMC8377507 DOI: 10.1089/dia.2020.0668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The goal of this study was to characterize trajectories of continuous glucose monitoring (CGM) use in youth 5-12 weeks after starting CGM and examine what factors differentiate between the trajectory groups. Parent-youth dyads completed assessments before starting CGM. Days of CGM use between weeks 5 and 12 were accessed through cloud-based data repository. Three patterns of use were observed among 96 youth (mean age 13.4 ± 2.75 years; 75% white): sustained high, declining, and sustained low. Youth in the sustained low and declining groups were more likely than those in the sustained high group to use a receiver (versus smart phone). There were no differences between the trajectory groups with respect to age, race, ethnicity, income, or insulin regimen. Future research should examine trajectory groups for a longer follow-up period and identify baseline factors that reliably predict which youth will have low or declining CGM use over time.
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Affiliation(s)
- Victoria A. Miller
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Address correspondence to, Victoria A. Miller, PhD, Division of Adolescent Medicine, Children's Hospital of Philadelphia, Buerger Room 12-219, Philadelphia, PA 19104-4399, USA
| | - Rui Xiao
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven M. Willi
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Miller VA, Xiao R, Slick N, Feudtner C, Willi SM. Youth Involvement in the Decision to Start CGM Predicts Subsequent CGM Use. Diabetes Care 2020; 43:2355-2361. [PMID: 32703764 PMCID: PMC7510031 DOI: 10.2337/dc20-0348] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The ability of continuous glucose monitoring (CGM) to improve diabetes outcomes depends upon consistent use. To identify factors that facilitate long-term use of CGM, this study tested the hypothesis that youth involvement in the decision to initiate this therapy would influence subsequent CGM use and that CGM self-efficacy and satisfaction mediate this relationship. RESEARCH DESIGN AND METHODS Before initiating CGM, parent-youth dyads (i.e., pairs) from an academic endocrinology clinic completed assessments, including a measure of the child's involvement in the decision to start CGM. Two months into CGM use, youth completed measures of CGM self-efficacy and satisfaction. Fidelity of CGM use between weeks 5 and 12 was accessed via a cloud-based data repository. Hypotheses were tested with linear mixed-effects models, accounting for patients clustered within provider and repeated measures within patients. RESULTS CGM use in 108 dyads (youth mean age 13.4 ± 2.7 years; 73% White) was positively predicted by baseline parent report of youth involvement in the CGM decision (P < 0.0001), and this relationship was mediated by youth's perceptions of CGM self-efficacy (P < 0.0001) and hassle (P = 0.014). So, when the youth shared their opinions about CGM with parents and participated in the decision to start, they perceived higher self-efficacy and lower hassle at 2-month follow-up, which predicted more days of use. This pattern held in models adjusting for youth race and sex and family income. CONCLUSIONS To achieve maximum clinical benefit from CGM use, providers should facilitate youth involvement in the decision to initiate the device.
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Affiliation(s)
- Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rui Xiao
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nathalie Slick
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Chris Feudtner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven M Willi
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Berget C, Driscoll KA, Lagges A, Lange S, DiMeglio LA, Hannon TS, Woerner SE, Iturralde E, Barley RC, Hanes S, Hood KK, Buckingham BB. Optimizing the use of continuous glucose monitoring in young children with type 1 diabetes with an adaptive study design and multiple randomizations. Contemp Clin Trials 2019; 82:60-65. [PMID: 31129370 DOI: 10.1016/j.cct.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/13/2019] [Accepted: 05/22/2019] [Indexed: 11/18/2022]
Abstract
Parents of young children with type 1 diabetes (T1D) experience unique, developmental challenges in managing their child's T1D, resulting in psychosocial distress. Only a small portion of young children reach glucose goals and adherence to diabetes devices that help improve T1D management have historically been low in this population. The purpose of this study is to test four interventions that couple developmentally tailored behavioral supports with education to optimize use of diabetes devices, improve glucose control, and reduce psychosocial distress for parents of young children with T1D. The study team designed four behavioral interventions, two aimed at improving glucose control and two aimed at optimizing use of diabetes devices. The goal of this paper is to describe the behavioral interventions developed for this study, including the results of a pilot test, and describe the methods and analysis plan to test this intervention strategy with ninety participants in a large-scale, randomized trial using a sequential multiple assignment randomization trial (SMART) design. A SMART design will permit a clinically relevant evaluation of the intervention strategy, as it allows multiple randomizations based on individualized assessments throughout the study instead of a fixed intervention dose seen in most traditional randomized controlled trials.
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Affiliation(s)
- Cari Berget
- University of Colorado Denver, School of Medicine, Barbara Davis Center for Childhood Diabetes, United States of America
| | - Kimberly A Driscoll
- University of Colorado Denver, School of Medicine, Barbara Davis Center for Childhood Diabetes, United States of America
| | - Ann Lagges
- Indiana University, School of Medicine, Clinical Psychiatry, United States of America
| | - Samantha Lange
- University of Colorado Denver, School of Medicine, Barbara Davis Center for Childhood Diabetes, United States of America
| | - Linda A DiMeglio
- Indiana University, School of Medicine, Pediatric Endocrinology/Diabetology, United States of America
| | - Tamara S Hannon
- Indiana University, School of Medicine, Pediatric Endocrinology/Diabetology, United States of America
| | - Stephanie E Woerner
- Indiana University, School of Medicine, Pediatric Endocrinology/Diabetology, United States of America
| | - Esti Iturralde
- Stanford University, School of Medicine, Pediatric Diabetes & Endocrinology, United States of America; Kaiser Permanente Norther California, Division of Research, United States of America
| | - Regan C Barley
- Stanford University, School of Medicine, Pediatric Diabetes & Endocrinology, United States of America
| | - Sarah Hanes
- Stanford University, School of Medicine, Pediatric Diabetes & Endocrinology, United States of America
| | - Korey K Hood
- Stanford University, School of Medicine, Pediatric Diabetes & Endocrinology, United States of America.
| | - Bruce B Buckingham
- Stanford University, School of Medicine, Pediatric Diabetes & Endocrinology, United States of America
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Maiorino MI, Petrizzo M, Bellastella G, Esposito K. Continuous glucose monitoring for patients with type 1 diabetes on multiple daily injections of insulin: pros and cons. Endocrine 2018; 59:62-65. [PMID: 28551774 DOI: 10.1007/s12020-017-1328-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/12/2017] [Indexed: 01/07/2023]
Abstract
Continuous glucose monitoring associated with intensive insulin regimens represents a useful tool to lower HbA1c in selected adults with type 1 diabetes. Recent randomized controlled trials demonstrated greater glycemic benefits in type 1 diabetic patients treated with multiple daily injections of insulin and continuous glucose monitoring over usual care. These positive outcomes, however, are counter-balanced by several limitations that restrict the use of continuous glucose monitoring in the real life, including the apparent lack of benefits in children and pregnant diabetic women, the high cost, the stringent patients' selection, and the presence of a multi-disciplinary team with specific expertise. Pros and Cons of using continuous glucose monitoring in type 1 diabetic patients with multiple daily injections of insulin are here discussed.
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Affiliation(s)
- Maria Ida Maiorino
- Department Medical, Surgical, Neurological, Metabolic Science and Aging, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Michela Petrizzo
- Diabetes Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Bellastella
- Department Medical, Surgical, Neurological, Metabolic Science and Aging, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Katherine Esposito
- Department Medical, Surgical, Neurological, Metabolic Science and Aging, University of Campania "Luigi Vanvitelli", Naples, Italy
- Diabetes Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Tansey M, Beck R, Ruedy K, Tamborlane W, Cheng P, Kollman C, Fox L, Weinzimer S, Mauras N, White NH, Tsalikian E. Persistently high glucose levels in young children with type 1 diabetes. Pediatr Diabetes 2016; 17:93-100. [PMID: 25496062 PMCID: PMC4465416 DOI: 10.1111/pedi.12248] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The aim of the study was to characterize glucose levels and variability in young children with type 1 diabetes (T1D). METHODS A total of 144 children of 4-10 yr old diagnosed with T1D prior to age 8 were recruited at five DirecNet centers. Participants used a continuous glucose monitor (CGM) every 3 months during an 18-month study. Among the 144 participants, 135 (mean age 7.0 yr, 47% female) had a minimum of 48 h of CGM data at more than five of seven visits and were included in analyses. CGM metrics for different times of day were analyzed. RESULTS Mean hemoglobin A1c (HbA1c) at the beginning and end of the study was 7.9% (63 mmol/mol). Fifty percent of participants had glucose levels >180 mg/dL (10.0 mmol/L) for >12 h/d and >250 mg/dL (13.9 mmol/L) for >6 h/d. Median time <70 mg/dL (3.9 mmol/L) was 66 min/d and <60 mg/dL (3.3 mmol/L) was 39 min/d. Mean amplitude of glycemic excursions (MAGE) was lowest overnight (00:00-06:00 hours). The percent of CGM values 71-180 mg/dL (3.9-10.0 mmol/L) and the overall mean glucose correlated with HbA1c at all visits. There were no differences in CGM mean glucose or coefficient of variation between the age groups of 4 and <6, 6 and <8, and 8 and <10. CONCLUSIONS Suboptimal glycemic control is common in young children with T1D as reflected by glucose levels in the hyperglycemic range for much of the day. New approaches to reduce postprandial glycemic excursions and increase time in the normal range for glucose in young children with T1D are critically needed. Glycemic targets in this age range should be revisited.
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Affiliation(s)
- M. Tansey
- University of Iowa, Pediatric Endocrinology, Iowa City, IA
| | - R. Beck
- Jaeb Center for Health Research, Tampa, FL
| | - K. Ruedy
- Jaeb Center for Health Research, Tampa, FL
| | - W. Tamborlane
- Yale University, Pediatric Endocrinology, New Haven, CT
| | - P. Cheng
- Jaeb Center for Health Research, Tampa, FL
| | - C. Kollman
- Jaeb Center for Health Research, Tampa, FL
| | - L. Fox
- Nemours Children’s Clinic, Pediatric Endocrinology, Jacksonville, FL
| | - S. Weinzimer
- Yale University, Pediatric Endocrinology, New Haven, CT
| | - N. Mauras
- Nemours Children’s Clinic, Pediatric Endocrinology, Jacksonville, FL
| | - N. H. White
- Washington University in St. Louis, Department of Pediatrics, St. Louis, MO
| | - E. Tsalikian
- University of Iowa, Pediatric Endocrinology, Iowa City, IA
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Laffel L. Improved Accuracy of Continuous Glucose Monitoring Systems in Pediatric Patients with Diabetes Mellitus: Results from Two Studies. Diabetes Technol Ther 2016; 18 Suppl 2:S223-33. [PMID: 26784126 PMCID: PMC4717517 DOI: 10.1089/dia.2015.0380] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study was designed to evaluate accuracy, performance, and safety of the Dexcom (San Diego, CA) G4(®) Platinum continuous glucose monitoring (CGM) system (G4P) compared with the Dexcom G4 Platinum with Software 505 algorithm (SW505) when used as adjunctive management to blood glucose (BG) monitoring over a 7-day period in youth, 2-17 years of age, with diabetes. RESEARCH DESIGN AND METHODS Youth wore either one or two sensors placed on the abdomen or upper buttocks for 7 days, calibrating the device twice daily with a uniform BG meter. Participants had one in-clinic session on Day 1, 4, or 7, during which fingerstick BG measurements (self-monitoring of blood glucose [SMBG]) were obtained every 30 ± 5 min for comparison with CGM, and in youth 6-17 years of age, reference YSI glucose measurements were obtained from arterialized venous blood collected every 15 ± 5 min for comparison with CGM. The sensor was removed by the participant/family after 7 days. RESULTS In comparison of 2,922 temporally paired points of CGM with the reference YSI measurement for G4P and 2,262 paired points for SW505, the mean absolute relative difference (MARD) was 17% for G4P versus 10% for SW505 (P < 0.0001). In comparison of 16,318 temporally paired points of CGM with SMBG for G4P and 4,264 paired points for SW505, MARD was 15% for G4P versus 13% for SW505 (P < 0.0001). Similarly, error grid analyses indicated superior performance with SW505 compared with G4P in comparison of CGM with YSI and CGM with SMBG results, with greater percentages of SW505 results falling within error grid Zone A or the combined Zones A plus B. There were no serious adverse events or device-related serious adverse events for either the G4P or the SW505, and there was no sensor breakoff. CONCLUSIONS The updated algorithm offers substantial improvements in accuracy and performance in pediatric patients with diabetes. Use of CGM with improved performance has potential to increase glucose time in range and improve glycemic outcomes for youth.
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Affiliation(s)
- Lori Laffel
- Pediatric, Adolescent and Young Adult and Genetics and Epidemiology Sections, Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
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