Healthcare providers should consider offering behavioural support to children with type 1 diabetes and their families when continuous glucose monitoring (CGM) is started, as this may improve satisfaction with diabetes technology and time-in-range.
In the Strategies to Enhance New CGM Use in Early Childhood (SENSE) study, the provision of family behavioural intervention training when young children started using CGM increased satisfaction with the monitors, decreased fear of hyperglycaemia and reduced diabetes burden. It also resulted in improved blood glucose time-in-range between enrolment and the end of the 6-month study.
SENSE compared self-monitoring of blood glucose with a meter and test strips, CGM, and CGM plus five 30-minute family behavioural intervention sessions in 143 children aged 2–7 years. The children, from 14 sites across the US, were randomly allocated to one of the three study arms. The use of CGM decreased glycaemic extremes compared to self-monitoring; however, there was no difference in time-in-target range (blood glucose: 3.9–10.0 mmol/L; 70–180 mg/dL) between the CGM plus behavioural education, CGM alone and self-monitoring groups, which was unexpected.
Despite its mixed results, principal investigator Professor Linda Anne DeMeglio from Indiana University School of Medicine said: “We were enthusiastic to see we moved the needle on time spent with low blood sugar, severe low blood sugar events and very high levels [with CGM]. We were encouraged to learn with advances in technology and caregiver support, caregivers for very young children with diabetes are able to improve outcomes for their children.”
Access to CGM is currently limited in the UK, yet the results of trials such as SENSE and CGM Intervention in Teens and Young Adults with Type 1 Diabetes (CITY) – which reported improved glucose levels and good adherence to treatment in adolescents who had previously had suboptimal glucose levels – point towards the benefits of CGM technology.
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