The ongoing coronavirus pandemic and the high number of COVID-19 patients with diabetes have heightened interest in real-time continuous glucose monitoring (CGM).
CGM is seen as a means to care for but minimize provider interaction with diabetes patients who have been hospitalized due to COVID-19, thereby reducing waste of personal protective equipment and opportunities for staff exposure to the virus, said Gregory P. Forlenza, MD.
Dr. Forlenza was one of four experts who discussed Expanding the Use of Continuous Glucose Monitoring in Pediatric Settings during this year’s Scientific Sessions. The presentation can be viewed by registered meeting attendees at ADA2020.org through September 10, 2020. If you haven’t registered for the Virtual 80th Scientific Sessions, register today to access all of the valuable meeting content.
Data from the U.S. Centers for Disease Control and Prevention indicate that about a third of patients hospitalized for COVID-19 have pre-existing diabetes, and these patients have worse morbidity and mortality outcomes than those without diabetes, said Dr. Forlenza, Assistant Professor in Pediatrics in the Barbara Davis Center for Diabetes at the University of Colorado. This has prompted the U.S. Food and Drug Administration to allow manufacturers to provide sensors, transmitters, and technical support to hospitals to allow for remote CGM for these patients.
CGM has helped facilitate socially distanced diabetes care in clinical practice, too.
“The ability to have remote access to data and time-in-range data when we’re doing telehealth consultations during the COVID pandemic has been fabulous,” said Jan Fairchild, FRACP, Staff Specialist in Pediatric Endocrinology and Diabetes at Women’s and Children’s Hospital in North Adelaide, Australia. “We may not be going back to face-to-face as often as we have in the past.”
Brigitte I. Frohnert, MD, PhD, Assistant Professor in Pediatrics in the Barbara Davis Center for Diabetes at the University of Colorado, noted that the ongoing TESS trial (Trial of Early Initiation of CGM-Guided Insulin Therapy in Stage 2 T1D: The Early Start Study) is designed to study the use of CGM clinically.
“CGM has several advantages for monitoring and prediction of progression,” Dr. Frohnert said. “There are opportunities for both therapeutic and educational benefits.”
Real-world experience also points to the benefits of CGM in early stage 3 type 1 diabetes, particularly in managing the postprandial rise and not overtreating hypoglycemia, explained Dr. Fairchild. She presented data on the impact of early CGM initiation on glycemic outcomes following the Australian government’s 2017 subsidization of CGM for type 1 diabetes patients under 21 years old.
“Equitable access to CGM has led to a relatively high uptake and continuation of CGM at our center,” said Dr. Fairchild, noting that more than half (58%) of the clinic’s patients wore their CGM device more than 75% of the time as of their last visit in 2019.
“Our next challenge is to get our families to look and act on that wonderful data we’ve got for them,” she added.
Fida Bacha, MD, FAAP, Associate Professor of Pediatrics, Pediatric Diabetes and Endocrinology, at Baylor College of Medicine, said data derived from CGM helps patients understand the effects of different foods, behaviors, physical activities, and medications on blood glucose. She discussed CGM use in youth with type 2 diabetes, which is less well studied than CGM use in type 1 diabetes patients or in adults with type 2 diabetes.
Available data indicates CGM may be beneficial for youth with type 2 diabetes who administer multiple daily insulin injections, or who are not meeting glycemic targets, she said.