ESPE Yearbook of Paediatric Endocrinology

Brief summary: In this large registry-based study, including 32 117 children and young people (aged 1.5–25 years) with type 1 diabetes (T1D), the use of continuous glucose monitoring (CGM) was associated with decreased rates of diabetic ketoacidosis (DKA) and severe hypoglycemia. Of interest, some CGM metrics predicted risk for these complications.

CGM systems are now widely used by children with T1D, and there is evidence both from clinical trials and real-word data that their use is associated with better glycemic outcomes (1). Indeed, international guidelines strongly recommend CGM use in all children, adolescents, and young adults with T1D (2).

This study investigated whether rates of acute complications of T1D, such as DKA and severe hypoglycemia, are lower in young people using CGM. The study reports real-world data collected from the large Diabetes Prospective Follow-up initiative (DPV), with available data from 511 paediatric diabetes centres across Austria, Germany, Luxembourg, and Switzerland. The study compared 10 883 participants using CGM to 21 234 using fingerstick blood glucose monitoring and clearly showed that the use of CGM was associated with lower rates of both severe hypoglycemia and DKA. More importantly, those using CGM had nearly half the incidence of hypoglycemic coma and severe DKA. Another key finding was that CGM metrics can help predict risk of these complications. Specifically, ≥4% of time below target glucose range (<3.9 mmol/l) and high glycemic variability (coefficient of variation ≥36%) were associated with higher risk of severe hypoglycemia. Mean sensor glucose ≧10.0 mmol/L or percentage of time in target glucose range (3.9–10 mmol/l) <50%, and above glucose range ≥50% were identified as robust risk markers of DKA.

Overall, this large study provides further support for the use of CGM in young people with T1D and highlights the value of CGM metrics to identify individuals at particular risk of acute severe complications who would benefit from timely interventions. However, although technology has definitely revolutionised the management of T1D, there are still barriers, such as costs and inequalities primarily associated with deprivation and ethnicity (3), which although not considered in the current study, need to be overcome to allow a wider access to the best available technology for all young people with T1D.

References: 1. Alonso GT, Triolo TM, Akturk HK, et al. Increased technology use associated with lower A1C in a large pediatric clinical population. Diabetes Care. 2023;46(6):1218–1222. 2. Tauschmann M, Forlenza G, Hood K, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Glucose monitoring. Pediatr Diabetes. 2022;23(8):1390–1405. 3. Ng SM, Evans ML. Widening health inequalities related to type 1 diabetes care in children and young people in the UK: A time to act now. Diabet Med. 2021;38(11):e14620.