International Society for Pediatric and Adolescent Diabetes
ISPAD 2014 | 40th Anniversary |
227
P137
An inpatient pilot study assessing the safety of using real-time sensor glucose values for
treatment decisions in adolescents with poorly-controlled type 1 diabetes mellitus (T1D)
L.A. Fox
1
, E. Balkman
1
, K. Englert
1
, J. Hossain
2
, N. Mauras
1
1
Nemours Children's Clinic, Jacksonville, United States,
2
Alfred I du Pont Hospital for Children,
Biostatistics Core, Wilmington, United States
Objectives:
CGM are FDA-approved for use with fingerstick glucose for treatment decisions. This
study explored whether real-time sensor glucose (SG) data used for treatment decisions would be
safe in adolescents with poorly-controlled T1D.
Methods:
10 pts with A1c ≥9% on CSII were admitted to CRC after lunch. A CGM was inserted.
Reference plasma glucose values were measured at least hourly using Yellow Springs Instrument
Glucose Analyzer (YSI). Starting at dinner, SG was used for treatment decisions unless any of the
following criteria were met: 1) YSI < 70; 2) SG < 70 and YSI >250; 3) absolute difference between SG
& YSI (AD
SG-YSI
) was above pt's insulin sensitivity factor (ISF) or >100; 4) rate of change of YSI
(ROC
YSI
) or SG (ROC
SG
) was < 60 but other was ≥60 mg/dL/hr; 5) YSI & SG were changing in
opposite directions. Participant was discharged after lunch the next day.
Results:
10 pts (7 males; 15.2-17.8 yrs old) completed the study. Mean (±SE) absolute difference
(MAD) and mean absolute relative difference (MARD) for SG vs. YSI were 30.4±4.1 mg/dL and
17.0±2.0%, respectively (range 14.0-53.3 mg/dL and 9.4-27.4%). A total of 32 (1-4/pt) high BG
corrections were given during CGM use, 9 (0-2/pt) used YSI glucose for correction: 7 because AD
SG-
YSI
was >ISF; 2 because ROC
YSI
< 60 and ROC
SG
was ≥60 mg/dL/hr. There were 5 episodes of mild
hypoglycemia (2 pts YSI < 70, 1 SG < 70); 2 episodes in 1 pt were symptomatic (YSI 61-68), 1 pt with
SG 47 had symptoms but YSI was 148. Two of 5 lows occurred after using SG for dose calculations.
Five doses using SG for calculations (1 in each of 5 pts) led to an increase of BG by >100 (range 101-
135) within 3 hours, none up to ≥350.
Conclusion:
Use of real-time CGM for treatment decisions in this study was safe. Correction and
mealtime doses using SG data did not result in significant over- or under-treatment. Use of SG for
treatment decisions under supervised inpatient conditions is a suitable alternative to repeated
fingerstick BG.
