'Flash' Glucose Monitoring Benefits Kids With Type 1 Diabetes

Latest studies of a 'flash' glucose monitoring system, Abbott's Freestyle Libre, show it as an adequate replacement for finger-prick glucose testing. And safe and accurate when used by children and young people with diabetes (4-17 years).


The Libre system comprises a small round glucose sensor worn for up to 14 days on the back of the upper arm and a scanner device that the patient waves over the sensor to obtain a reading of glucose concentrations in the interstitial fluid. The scans display both historical and current glucose trends. Glucose measurements can be taken through clothing, and the sensor is water-resistant and can be worn while swimming and bathing.


The system measures interstitial tissue glucose levels every minute via a disposable round sensor about the size of a $1 coin, with a small catheter inserted under the skin, worn on the back of the upper arm for up to 14 days. The wearer scans the sensor with a reader, which generates a real-time glucose test, an 8-hour trend history, and the direction glucose is heading.


However, finger-prick measurements are still required when blood glucose levels are rapidly changing, since interstitial fluid glucose levels may not accurately reflect the current blood level.


Finger-prick testing is also advised when the system reports hypoglycemia or impending hypoglycemia or when the patient's symptoms don't match the device's readings.


Latest studies used a blinded version of the FreeStyle Libre system in the current prospective, single-arm study, involving 89 children aged 4 to 17 years with type 1 diabetes in nine UK diabetes centers. Participants were asked to perform four capillary blood glucose tests daily, each immediately followed by a sensor reading. The data were unmasked on the third and final visit, at 12 to 15 days.


Study results were released online on January 31 in theArchives of Disease in Childhoodby Julie Edge, MB ChB, paediatric endocrinology and diabetes, Oxford Children's Hospital, United Kingdom, and colleagues.


Results after 14 days show that overall the mean absolute relative difference between blood glucose measurements and the Freestyle Libre sensor was 13.9%, with 83.8% of results in zone A and 99.4% in zones A or B of the "consensus error grid," a model developed to assess continuous glucose monitoring accuracy.


Unlike current CGM devices, the Libre was approved as an alternative to routine blood glucose monitoring, and diabetes patients can use the results to guide therapeutic decisions.


The system was granted a CE Mark in Europe in 2014 as a replacement for finger-prick glucose monitoring in people with diabetes (any type) down to 4 years of age and is now available in 28 countries, with almost 200,000 users globally.


"The FreeStyle Libre System is not a CGM device - with FreeStyle Libre Abbott has developed a new category, of flash glucose monitoring," a company spokesperson said.


CGM and Finger-prick Testing Can Be Problematic in Kids

Dr Edge and colleagues note in their paper that monitoring of blood glucose levels in children and adolescents by finger-prick testing can be challenging, due to unpredictable and increased frequency of food intake, variable patterns of physical activity, and psychological and hormonal changes during adolescence, among other issues. This in turn can lead to greater glycemic variability, wider glycemic excursions, and more frequent hypoglycemia than seen in adults.


And monitoring glucose via CGM is problematic in children and adolescents too, for a number of reasons, the team notes. The FreeStyle Libre System "potentially resolves many of the issues that affect adherence with CGM," Dr Edge and colleagues point out.


Type 1 diabetes exchange data indicate that the majority (>75%) of children/young people with diabetes do not meet International Society for Paediatric and Adolescent Diabetes/American Diabetes Association guidelines for glycaemic control (glycated haemoglobin <58 mmol/mol (7.5%)).

Results of latest study published in the Archives of Disease in Children

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