ESPEYB21 13. Global Health for the Paediatric Endocrinologist Diabetes and Diabetes Technology (5 abstracts)
13.1. Feasibility of continuous glucose monitoring in patients with type 1 diabetes at two district hospitals in Neno, Malawi: a randomised controlled trial
Gomber A , Valeta F , Coates MM , Trujillo C , Ferrari G , Boti M , Kumwenda K , Mailosi B , Nakotwa D , Drown L , Wroe EB , Thapa A , Mithi V , Matanje B , Msekandiana A , Park PH , Kachimanga C , Bukhman G , Ruderman T & Adler AJ
BMJ Open. 2024 May 6;14(5):e075554.PMID 38719319
Brief Summary: This randomized-control study at two rural hospitals in Malawi investigated the feasibility of continuous glucose monitoring (CGM) to improve care of patients with Type 1 diabetes (T1D) in a low-income and limited literacy setting. CGM was feasible with potential benefits, but the authors highlight several challenges in implementing advanced diabetes care in such settings.
This trial 2:1 randomized 45 patients with T1D to Dexcom G6 CGM (n=30) or usual care (UC) using a blood glucose meter (n=15) for 3 months. Providers were trained to review downloads and logbook data, make dose adjustments and recommend lifestyle change at follow up visits scheduled monthly. Those in the CGM arm were seen more often for sensor changes. Baseline characteristics of both groups were similar. WHO Quality of Life Brief Version (WHOQOL-BREF) and HbA1c were primary outcomes.
Sensors were used 68% of the time in the CGM group. Inability to change sensors at home led to more visits in this group. UC participants brought logbooks to visits 75% of the time, but with glucose readings only 51.3% of the time. More insulin adjustments were made in the CGM arm (1.2 per person) than the UC arm (0.2 per person). More recommended lifestyle changes were made in the CGM arm (0.4 per person) than the UC arm (0.2). In the CGM arm, the average time in range (TIR) was 30.8% in week 1 and 38.7% in week 10. CGM was associated with a 1.1% lower HbA1c vs UC (adjusted for baseline HbA1c and covariates), but this trend was not statistically significant. Similarly, quality of life was improved across all domains, but was not significantly different between groups. The most significant issue for utilization was limited digital literacy of patients to use CGM devices independently.
CGM was feasible and appropriate in this rural setting, but challenges with sensor changes and digital literacy need addressing. The study highlights the potential of CGM to improve diabetes management in low-resource settings but calls for further research, particularly on newer, more user-friendly CGM models.
Reference: 1. Battelino T, Alexander CM, Amiel SA, et al. Continuous glucose monitoring and metrics for clinical trials: an international consensus statement. Lancet Diabetes Endocrinol 2023;11:42–57.
Volume 21
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ESPE Yearbook of Paediatric Endocrinology
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