[Accuracy, utility and complications of continuous glucose monitoring system (CGMS) in pediatric patients with type 1 diabetes].
OBJECTIVE
To evaluate the accuracy, utility and complications of continuous glucose monitoring system in children and adolescents with type 1 diabetes.


METHODS
This retrospective study assessed 16 type 1 diabetic patients (16.12+/-4.41 years) submitted to continuous glucose monitoring system (Medtronic; Northridge, CA) for 72 hours. The following parameters were analyzed: mean capillary glucose level and mean glucose value measured by the continuous glucose monitoring system; glucose excursions (continuous glucose monitoring system vs. capillary glucose measurement), postprandial hyperglycemia (NR < 140 mg/dl), nocturnal hypoglycemia, complications (trauma, local infection, disconnection) and therapeutic management after continuous glucose monitoring. A1c levels were measured at the beginning and after 3 months of the study.


RESULTS
The mean capillary glucose values were 214.3+/-66.5 mg/dl vs. 207.6+/-54.6 mg/dl by continuous glucose monitoring system, with a significant correlation (p = 0.001). The correlation coefficient and mean absolute error were 0.86+/-0.21 and 12.6% of the median, respectively. The continuous glucose monitoring system was significantly more efficient in detecting glucose excursion than fingerstick capillary blood sampling (p = 0.04; W = 74), and postprandial hyperglycemia was identified in 60% of type 1 diabetic patients with a median value of 157 mg/dl (< 140 mg/dl). Nocturnal hypoglycemia was detected in 46.7% of these patients. The evaluation of A1c levels in eight (50%) patients before continuous glucose monitoring and after 3 months showed a significantly lower level of A1c in this population (8.18+/-1.5 vs. 7.28+/-1.3; p = 0.034). The therapeutic management of type 1 diabetes was changed in 100% of patients. No complications were detected in 93.7% of patients.


CONCLUSIONS
The continuous glucose monitoring system showed to be a very safe, well-tolerated and highly accurate method, with a low complication rate. It is a good method to identify glucose excursion and postprandial hyperglycemia, and to improve metabolic changes in therapeutic strategies, with a significant impact on the A1c levels of pediatric diabetic patients. The efficacy of the continuous glucose monitoring system in detecting hypoglycemia is still unclear in the medical literature.
Maia
Frederico F R
FF
Faculdade de Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, MG, Brazil. fredfrm@hotmail.com
Araújo
Levimar R
LR
D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000009:adverse effects / Q000295:instrumentation* / Q000592:standards; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D018670:Monitoring, Ambulatory / Q000009:adverse effects / Q000295:instrumentation* / Q000592:standards; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin