Type 1 diabetes

Teens have 50% dropout rate for CGM

Despite gaining fully subsidised access to Continuous Glucose Monitoring (CGM) sensors two years ago, half of adolescents who start using the devices do not persist with them, experience at a Sydney diabetes centre shows.

A six month follow up of 45 adolescents with type 1 diabetes who started CGM at the Westmead Hospital Young Adult Clinic found that only 50% continued using them beyond the first few weeks. Common reasons for discontinuing them included discomfort and interference with activities such as sport, said review author Dr Myron Lee, an endocrinologist at the centre.

Presenting the preliminary results at ADC 2018, he said CGM users tended to be female and to have a higher socioeconomic background despite there being minimal cost associated with the devices. Previous use of an insulin pump was also a predictive factor for continuing use of CGM, likely due to the existing familiarity with devices and the additional benefits of augmenting pump function with predictive low glucose suspend.

“Fear of hypoglycaemia appeared to be a large motivating factor for commencing CGM,” he said, noting that CGM use appeared to have eased fears of hypoglycaemic symptoms when patients were surveyed after six months of use.

The small number of patients did not provide enough data to draw conclusions on the impact of CGM on glycaemic parameters, but there were trends showing reductions in HbA1c levels and also in markers of  glycaemic variability such as time in range at six months, after an initial ‘learning curve’ deterioration.

Dr Lee said the CGM devices were becoming more popular over time, and this meant the clinic now had to hold group instruction sessions to initiate six or more patients at one time to manage demand.

In a separate presentation at ADC 2018, Melbourne based endocrinologist Dr Peter Colman said national data on glycaemic outcomes with CGM use were now being collated by the Australian Diabetes Data Network.

While the NDSS held usage data, the ADDN was the only database of clinical data, he told the meeting.

“This will be a unique opportunity to look at usage and outcomes of CGM in young people,” he said.

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