Continuous Glucose Monitoring Versus Finger-Prick Self-Monitoring For Pediatric Glycemic Control: A Prospective Randomized Comparative Study
Keywords:
Continuous glucose monitoring, pediatric diabetes, Time in Range, HbA1c, glycemic variabilityAbstract
Background: Continuous glucose monitoring (CGM) has been more and more encouraged in children and adolescents with type 1 diabetes due to its capacity to offer more glycemic indicators, such as Time in Range (TIR), than traditional ones, such as glycated hemoglobin (HbA1c). The comparative data at resource settings variable however are sparse.
Aim: To compare the effectiveness of CGM versus finger-prick self-monitoring of blood glucose (SMBG) in improving glycemic control among pediatric patients with type 1 diabetes.
Methods: A 28-week randomized controlled study was carried out at Baghdad Welfare Children Hospital on 120 children and adolescents (617 years) with type 1 diabetes. The participants were randomly divided into CGM (n = 60) and SMBG (n = 60). The first consequence was TIR change (70180 mg/dL). HbA1c, time above range (TAR), time below range (TBR), glycemic variability, and frequency of hypoglycemia were the secondary outcomes. ANCOVA adjustment and multivariate regression modelling were used in analyses.
Findings: CGM was much higher in TIR at 24 weeks than SMBG ( +8.4% vs +2.1%; mean difference 6.3, 95% CI 2.939.67; p < 0.001). The difference was also significant after adjustment (adjusted mean difference 5.5, p = 0.001). The CGM group had a reduction of HbA1c of −0.65% compared to SMBG of -0.18% (adjusted difference -0.46, p=0.001). Another significant reduction of TAR (−7.2 vs -1.9, p = 0.003) and TBR (−0.9 vs -0.2, p = 0.02), symptomatic hypoglycemia (1.5 vs 2.3 events/month, p = 0.01), and glycemic variability was also noted in CGM. The results of multivariate regression supported CGM as a predictor of HbA1c reduction independently (B = -0.46, p = 0.001).
Conclusion: CGM showed statistically and clinically significant better results compared to the performance of finger-prick monitoring in enhancing pediatric glycemic control. The findings suggest the use of CGM as a more desirable method of monitoring in children and adolescents with type 1 diabetes.
References
1. Biester T, Danne T, Kapellen T, et al. ISPAD Clinical Practice Consensus Guidelines 2024: Diabetes technologies—Glucose monitoring. Pediatr Diabetes. 2024.
2. Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593–1603.
3. Miller KM, Foster NC, Beck RW, et al. Current state of glucose monitoring in youth with type 1 diabetes. Diabetes Technol Ther. 2020;22(S1):S1–S12.
4. Hilliard ME, Yi-Frazier JP, Hessler D, et al. Psychological burden of glucose monitoring in youth with type 1 diabetes. Diabetes Care. 2019;42(6):1009–1016.
5. Beck RW, Riddlesworth T, Ruedy K, et al. Continuous glucose monitoring versus usual care in patients with type 1 diabetes receiving multiple daily insulin injections: A randomized trial. N Engl J Med. 2017;376(16):1507–1516.
6. Laffel LM, Kanapka LG, Beck RW, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes. JAMA. 2020;323(23):2388–2396.
7. Seidu S, Kunutsor SK, Cos X, et al. Efficacy and Safety of Continuous Glucose Monitoring and Intermittently Scanned Continuous Glucose Monitoring Compared With Usual Care: Systematic Review and Meta-analysis. Diabetes Care. 2024;47(1):169–179.
8. Zhou Y, Guo J, Luo Y, et al. Real-time versus intermittently scanned continuous glucose monitoring in type 1 diabetes: A systematic review and meta-analysis. Diabet Med. 2024;41:e15124.
9. Beck RW, Bergenstal RM, Riddlesworth TD, et al. Validation of Time in Range as an outcome measure for diabetes clinical trials. Diabetes Care. 2019;42(3):400–405.
10. Monnier L, Colette C, Owens DR. Glycemic variability: The third component of dysglycemia in diabetes. Diabetes Care. 2006;29(2):455–460.
11. Mann EA, Raghinaru D, Beck RW, et al. Early continuous glucose monitor use in children and adolescents with type 1 diabetes and association with glycemic outcomes. Diabetes Care. 2024;48(5):768–776.
12. American Diabetes Association Professional Practice Committee. Glycemic Targets: Standards of Care in Diabetes—2024. Diabetes Care. 2026;49(Suppl 1):S97–S110.
13. Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017;40(12):1631–1640.
14. Riddlesworth TD, Beck RW, Gal RL, et al. Optimal sampling duration for continuous glucose monitoring to determine glycemic metrics. Diabetes Technol Ther. 2018;20(4):314–316.
15. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359(14):1464–1476.
16. Agiostratidou G, Anhalt H, Ball D, et al. Standardizing clinically meaningful outcome measures beyond HbA1c for type 1 diabetes. Diabetes Care. 2017;40(12):1622–1630.
