Background: Advances in technology have led to new approaches in diabetes management. CGM has been associated with improvements in HbA1c, however, the evidence is limited and there are substantial cost considerations. The main aim of this audit was to assess the impact of CGM and FGS on HbA1c levels.
Method: A retrospective analysis of the use of CGM and FGS in paediatric patients under the care of the childrens diabetes team at James Cook Hospital, Middlesbrough. Registers for patients started on CGM and FGS were used to identify patients, and electronic notes analysed. Patients were discounted from the HbA1c analysis if there was insufficient data. For CGM, a total of 23 patients were identified, 1 of whom was discounted. For FGS, 32 patients were identified and 16 were discounted. For both sets of patients, HbA1c levels were noted prior to starting CGM or FGS and after 6, 12 and 24 months of use. In this audit, we also analysed referral criteria for CGM by comparing with NICE guidance.
Results: After 6 months of use, the percentage of patients whose HbA1c level stayed the same or reduced after commencement of CGM/FGS was only 36% for CGM and 50% for FGS. For both groups, this percentage improved with longer use. This demonstrates a disappointing reduction in HbA1c despite use of this technology. However, the group of patients with longer duration of both CGM and FGS use achieved greater reductions in HbA1c. This may demonstrate more effective use of the technology by families over time. We must consider the limitations of this data, particularly patient numbers with increasing time-periods on CGM/FGS and regarding documentation. We should also consider other possible beneficial effects of the devices not assessed, such as reduced anxiety and improved awareness of hypoglycaemia. 82.6% of patients had documentation of compliance with NICE guidance.
Outcome: In the future, all families will complete a quality of life questionnaire when initiating CGM/FGS and annually during use. We will also clearly document; date when CGM/FGS initiated, education delivered in line with ACDC guidance and how NICE criteria were met.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes