The number of children and young adults with type 1 diabetes who use a continuous glucose monitoring (CGM) system has increased dramatically in recent years, and using a CGM system is linked to better blood glucose control, according to a new study published in the journal Diabetes Technology & Therapeutics.
CGM systems use a sensor inserted through the skin (or implanted under the skin) — typically worn on the upper arm — to monitor glucose levels at regular intervals, typically every minute or every five minutes. Depending on the system, these readings can be sent to and stored on either a dedicated device or an app in your smartphone — allowing you and your doctor to look at your glucose trends over time, including on charts and graphs. You can also configure CGM systems to sound (or vibrate) and alarm when your glucose level is higher or lower than a certain threshold, or if your glucose level is dropping rapidly. Previous research has shown that among teens and young adults with type 1 diabetes, using a CGM system is linked to better blood glucose control compared with traditional blood glucose monitoring.
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For the latest study, researchers looked at rates of CGM use among children and young adults (under age 25) in nine different U.S. health systems, as well as 402 health locations in Germany, Austria, Switzerland, and Luxembourg. They found that among U.S. study participants, the proportion who used a CGM system nearly doubled between 2017 and 2020, growing from 25% to 49%. These numbers lagged behind European participants, though, who saw also saw a near-doubling in CGM use from 40% to 76% during the same period.
When it came to more specific age groups, rates of CGM use in the United States rose from 34% to 55% for participants under age 6, from 29% to 51% for participants ages 6 to under 12, from 22% to 43% for participants ages 12 to under 18, and from 26% to 46% for participants ages 18 to under 25. Use of CGM systems was greater among European participants in every age group in every year, with the exception of participants ages 18 to under 25 — who saw CGM use increase from 23% to 58% between 2017 and 2020.
CGM user linked to lower A1C levels
The researchers found that CGM users tended to have a lower A1C level (a measure of long-term blood glucose control) than participants who didn’t use CGM, regardless of whether they used an insulin pump or took multiple daily injections of insulin. Among U.S. insulin pump users in 2020, those who used CGM had an average A1C level of 8.1%, compared with 8.3% for those who didn’t use CGM. Among European insulin pump users in 2020, the corresponding A1c levels were 7.7% for CGM users and 8.0% for CGM nonusers.
Among U.S. participants who took multiple daily insulin injections in 2020, those who used CGM had an average A1C level of 8.7%, compared with 9.1% for those who didn’t use CGM. Among European participants who took multiple daily insulin injections in 2020, the corresponding A1C levels were 7.6% for CGM users and 7.9% for CGM nonusers.
The researchers noted that the recent increases in CGM use are not surprising, since other data in recent years has pointed to this trend. But this increase does show that the demonstrated benefits of CGM systems — as seen in study participants — may be persuading doctors that they are highly beneficial and worth prescribing. Of course, the study also showed that CGM use is much greater in Europe than in the United States, which the researchers noted could be due to differences in health care systems, insurance coverage, regulatory approval, and the overall cost of CGM systems.
“As CGM use continues to increase worldwide, it will remain important to monitor the impact on clinical outcomes and quality of life in people with diabetes,” the researchers wrote. “Quality improvement interventions to enhance CGM uptake, advocacy efforts promoting improved insurance coverage, and tailored clinical education to optimize personal use of CGM […] have potential to improve clinical outcomes in pediatric diabetes.”
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