Answering clinically pertinent questions with real-world data from paediatric type 1 diabetes registries

The beneficial impact of continuous glucose monitoring (CGM) was shown in adults with type 1 diabetes by the landmark JDRF trial in 2008. 1 Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008; 359: 1464-1476 Crossref PubMed Scopus (1264) Google Scholar Yet, for both children and adolescents, limited sensor wear mitigated the ability to detect differences in HbA1c with sensor use. 1 Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008; 359: 1464-1476 Crossref PubMed Scopus (1264) Google Scholar However, since that time, trials have shown benefits of sensor therapy in children and adolescents, 2 Laffel L Kanapka LG Beck RW et al. Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes: a randomized clinical trial. JAMA. 2020; 323: 2388-2396 Crossref PubMed Scopus (150) Google Scholar with real world data echoing these results. 3 DeSalvo DJ Lanzinger S Noor N et al. Transatlantic comparison of pediatric continuous glucose monitoring use in the Diabetes-Patienten-Verlaufsdokumentation Initiative and Type 1 Diabetes Exchange Quality Improvement Collaborative. Diabetes Technol Ther. 2022; 24: 920-924 Crossref PubMed Scopus (3) Google Scholar Furthermore, use of CGM permits a more nuanced assessment of glycaemia, as time in various ranges can be explored. Achievement of glycaemic targets is associated with decreased risk of long-term microvascular and macrovascular complications, with findings from a post-hoc analysis from the Diabetes Control and Complications Trial (DCCT) showing that, for each 10% decrease in time in target range of 70–180 mg/dL (3·9–10·0 mmol/L), there was a 64% increase in retinopathy progression and 40% increase in microalbuminuria. 4 Beck RW Bergenstal RM Riddlesworth TD et al. Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care. 2019; 42: 400-405 Crossref PubMed Scopus (419) Google Scholar Continuous glucose monitoring versus blood glucose monitoring for risk of severe hypoglycaemia and diabetic ketoacidosis in children, adolescents, and young adults with type 1 diabetes: a population-based studyThese findings provide evidence that continuous glucose monitoring can reduce severe hypoglycaemia and ketoacidosis risk in young people with type 1 diabetes on insulin therapy. Continuous glucose monitoring metrics might help to identify those at risk for acute diabetes complications. Full-Text PDF