ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This pilot study assessed the feasibility and impact of continuous glucose monitoring (CGM) in 9 adolescents with T2D. CGM use lowered HbA1c by up to 3.8% in participants who consistently used the device.

Comment: Large cohort studies investigating complications in children and adolescents with T2D have clearly shown a higher incidence of complications compared to both adults with T2D and children with type 1 diabetes (T1D). These complications often emerge at an early age and are strongly associated with poor glycemic control.

Among children and adolescents with T1D, the use of continuous glucose monitors (CGMs) alone improves outcomes and is now considered standard of care. This pilot study assessed the feasibility of CGM use and its effect on glycemic outcomes in youth with T2D. Nine adolescents, mean age 17.4±2.0 years, with a T2D duration of 4.0±2.8 years, and HbA1c 11.5±2.5%. were randomized to 3 months of Dexcom G6 CGM or blood glucose monitoring (BGM), followed by 3 months washout period and then crossed over to the other arm for 3 months.

CGM use lowered HbA1c by 2.8% in the CGM group, and by 3.8% for those who wore the CGM >85% of the time. Despite being a preliminary investigation with a very small sample, its findings are notable. It appears that the adolescent community with T2D, despite being at high-risk for early complications, is not receiving the level of care it requires. In a study assessing whether clinicians are sufficiently aggressive in treating diabetes-related dyslipidemia in youth, only 5% of those with dyslipidemia were prescribed lipid-lowering medications.² Similarly, in the TODAY study cohort, only half of the youth with hypertension were on blood pressure-lowering medication. While it may be easy to attribute this to patient behavior, it is also possible that because, unlike T1D where there is an immediate risk of ketoacidosis, and due to outdated perceptions that complications in T2D appear later in life, healthcare teams may not be adopting an aggressive enough approach.

A larger, more comprehensive study is needed to assess the impact of recent technologies in adolescents with T2D.

References: 1. Schoelwer, M.J., DeBoer, M.D. & Breton, M.D. Use of diabetes technology in children. Diabetologia (2024). https://doi.org/10.1007/s00125-024-06218-0.2. Jackson S, Creo A, Kumar S. Are Clinicians Aggressive Enough in Treating Diabetes-Related Hyperlipidemia in Youth? Curr Atheroscler Rep. 2022 Jun;24(6):471-481. doi:10.1007/s11883-022-01020-y.