Endocrine Abstracts

Background: Real-Time Continuous Glucose Monitoring Systems (RT-CGMS) represent a minimally invasive method for frequent glucose monitoring, allowing a better glycemic control for patients with type 1 diabetes. With the occasion of implementing the National Program for free access to RT-CGMS, we assessed the 6 months impact of RT-CGMS on the metabolic control, evaluated by glycated haemoglobin (HbA1c).

Methods: In this unicentric, prospective cohort study, we assigned patients with type 1 diabetes, aged less than 18 years, receiving the free RT-CGMS from a pediatric diabetes centre and returning for the 6 months resupply visit by January 9th, 2020. The allowed 6 months visit window was ±30 days. Patients were divided into two groups according to whether they already had a RT-CGMS at baseline or not: RT-CGMS+ (with RT-CGMS already used at baseline) and RT-CGMS- (without RT-CGMS at baseline).

Results: The study was completed by 63 patients, 28 women (44.4%), mean age 10.1 ± 3.8 (range: 3.1–17.9) years, mean diabetes duration at baseline 5.1 ± 3.4 years, who were evaluated at baseline and at 180.8 ± 11.5 days. The RT-CGMS+ group had 31 patients, mean age 9.9 ± 3.7 years, mean diabetes duration 5.2 ± 3.0 years, mean HbA1c at baseline 7.3 ± 0.7% (56 mmol/mol). The RT-CGMS- group had 32 patients, mean age 10.3 ± 3.9 years (P = 0.67 vs RT-CGMS+), mean diabetes duration 4.9 ± 3.8 years (P = 0.73 vs RT-CGMS+), and baseline HbA1c 7.9 ± 1.1% (63 mmol/mol, P < 0.01 vs RT-CGMS+). The HbA1c significantly rose at 6 months in RTCGMS+ group to 7.5 ± 0.7% (58 mmol/mol, P < 0.01 vs baseline). However, in the RT-CGMS- group, the HbA1c didn’t have a significant change at 6 months, reaching 8.0 ± 1.0% (64 mmol/mol, P = 0.71 vs baseline).

Conclusions: The introduction of a RT-CGMS to patients without previous access to this technology was associated with a complete resolution of the natural tendency towards an increase in HbA1c at 6 months, which was seen in patients already using a RT-CGMS and continued to use it for another 6 months. A possible explanation for the HbA1c increase registered in children already on RT-CGMS at baseline might be the effect of summer months when diabetes management was possible less stringent. Further work is needed to verify this hypothesis.