Starting CGM at diagnosis of T1D ensures high uptake and continuation

Type 1 diabetes

By Michael Woodhead

1 Dec 2021

Starting Continuous Glucose Monitoring (CGM) in children at diagnosis of type 1 diabetes is well received by families and leads to high uptake and long term continuation, a South Australian study has found

With significant numbers of children with T1D not starting or continuing CGM despite it now being fully funded by government, clinicians at the Women’s and Children’s Hospital, Adelaide, assessed the impact of offering CGM at diagnosis.

In a cohort of 77 children and adolescents with new onset T1D diagnosed after government subsidisation (May 2017) all were offered the DexCom G5 CGM prior to discharge from initial hospitalisation (average 3 days post diagnosis) as part of routine diabetes care.

Uptake was high, with 65 children (84%) started on CGM at diagnosis, 88% by 12 months and 90% by 24 months. Contunuation with CGM was also high,  with 78% of this cohort were wearing CGM consistently (>75% of the time) at 24 months after starting.

The uptake and continuation was not significantly higher than a comparator group of 65 new onset T1D patients diagnosed in the preceding year who had received identical diabetes education and management, all of whom were offered CGM following Government subsidisation in April 2017. In this cohort, 78% had started CGM by 12 months after subsidisation and 66% were wearing CGM consistently at 24 months. The median time for CGM start was 10 months.

The main reasons for not starting CGM included psychosocial issues, inability to afford/access a receiver device/phone and family preference. The main reasons for discontinuation were similar to those seen in previous studies, such as discomfort, dislike of alarms and psychological issues associated with wearing the CGM device.

According to researchers writing in Pediatric Diabetes, the rates of consistent CGM use seen in the study were higher than in the WCH Diabetes Clinic as a whole (58%).

They said previous studies had shown that commencing CGM in children in the first year post diagnosis leads to improved HbA1c outcomes, and therefore uptake and continuation would be important for improving an individual’s long-term trajectory of glycaemic control.

They noted there was no difference in demonstrate a significant difference in HbA1c between the cohorts, but the patient numbers were relatively small.

“If we are to improve outcomes, the challenge now is to overcome the other barriers to uptake and usage of this technology,” they wrote.

Having shown that starting CGM at diagnosis is feasible and well accepted by families, the clinic has continued this practice as part of routine care, they said.

The high uptake had proved valuable during the recent COVID19 pandemic, when telehealth appointments became necessary.

“CGM provided access to  comprehensive information, including time in range data, when HbA1c was unavailable and considerably enhanced the clinical advice we were able to provide,” they wrote.

“CGM is the gateway to closed loop therapy, with hybrid closed loop systems currently commercially available and full closed loop therapy systems likely available in the near future. These systems will allow further improvements in glycaemic control and long term health outcomes and strengthen the case for Government subsidisation of insulin pumps as well as CGM in Australia,” they concluded.

Already a member?

Login to keep reading.

OR
Email me a login link