Aim This literature review seeks to establish whether sufficient evidence showing an additional benefit of continuous glucose monitoring (CGM) on diabetes outcomes compared to intermittent self monitoring of blood glucose (SMBG) alone, in type 1 diabetic children, is available.
Methods Electronic databases were searched using a specific search strategy. Hand searches of relevant journals and of reference lists of relevant articles were carried out. Studies eligible for inclusion were published randomised controlled trials (RCTs) investigating the efficacy of CGMS as an adjunct to SMBG in children/adolescents with T1DM, compared to intermittent SMBG alone. Included studies were evaluated for methodological quality. Data was extracted on study design and relevant outcomes.
Results The search yielded 5 RCTs comparing retrospective CGMS with SMBG involving 137 participants aged 2-19 years. The search also yielded another 8 RCTs and 2 follow on studies of 2 of the RCTs which compared real time CGMS with SMBG, involving 554 participants aged 1-18 years. Three out of 5 studies of retrospective CGMS did not find any additional benefit of CGMS on HbA1c. In all the studies of real time CGMS a correlation between frequency of CGMS use and decrease in HbA1c was found, with regular CGM use being associated with a decrease in HbA1c of between 0.5% to 1.0%. Some of the trials confirmed a decrease in glycaemic variability, a decreased exposure to hypoglycaemia and of time with glucose values out of range. Satisfaction with CGM was high but in spite of this most children chose not to use sensors regularly implying an increased treatment burden.
Conclusion There is evidence that CGMS improves health outcomes in children but only if device is actually used regularly. This seems to be a problem with children and adolescents. Before it can be used routinely in clinical practice, user friendly devices need to be developed. More research is needed to confirm its impact on glycaemic parameters, its usefulness as a preventive tool of severe hypoglycaemia and to identify subjects most likely to benefit.
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