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Case for funding of continuous glucose monitoring systems for patients with recurrent hypoglycaemia
  1. Sze May Ng1,2,3,
  2. Sarah Dearman4,
  3. Mark Fisher4,
  4. Talat Mushtaq5,
  5. Tabitha Randell6
  6. on behalf of the British Society of Paediatric Endocrinology and Diabetes UK and the UK Children’s Hyperinsulinism Charity
  1. 1Paediatric Department, Southport and Ormskirk Hospital NHS Trust, Southport, Sefton, UK
  2. 2Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK
  3. 3Edge Hill University, Ormskirk, UK
  4. 4UK Children's Hyperinsulinism Charity, London, UK
  5. 5Leeds Teaching Hospitals NHS Trust, Leeds, UK
  6. 6Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. Correspondence to Professor Sze May Ng, Paediatric Department, Southport and Ormskirk Hospital NHS Trust, Southport L39 2AZ, Sefton, UK; may.ng{at}nhs.net

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Introduction

Continuous glucose monitoring (CGM) allows real-time interstitial glucose monitoring, therefore reducing the need for regular fingerprick blood testing.1 CGM also informs users of glucose trend data and alarms, which warns users of high or low blood glucose readings. There is a paucity of evidence on the use of CGM in patients without diabetes, but early data suggest that CGM can reduce episodes of hypoglycaemia in conditions such as hyperinsulinism and metabolic disorders.1 2 Real-time CGM was shown to provide valuable insights into patterns of dysglycaemia, where rapid fluctuations were found in glucose levels in babies with hyperinsulinism. CGM used as an adjunct to clinical care was shown to support the management of persistent neonatal hypoglycaemia in the unit and limited the need for frequent and painful blood sampling in these babies.2

Congenital hyperinsulinism is the most frequent cause of severe, persistent hypoglycaemia in children and consists of persistent and transient forms. A number of different genetic defects cause persistent forms of hyperinsulinism, while transient hyperinsulinism often resolves completely in days or months. Severe, persistent and frequent hypoglycaemia is a potentially life-threatening complication of congenital hyperinsulinism and may lead to permanent brain damage, presenting as significant developmental delay and/or mild to severe neurocognitive difficulties. Hypoglycaemia secondary to these conditions is serious, with almost 50% of children demonstrating neurological impairments as a result of recurrent hypoglycaemic events.3 The aim for treatment management is to reduce overall exposure to symptomatic and asymptomatic hypoglycaemia, to improve hypoglycaemia awareness and to reduce the fear of hypoglycaemia. The current standards of care for these patients are frequent observations and intermittent fingerprick blood testing. However, this provides no details of CGM trends with no alarm settings, resulting in patients and carers missing hypoglycaemia between infrequent fingerpick blood tests.

CGM devices …

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Footnotes

  • Twitter @mayng888

  • Contributors SMN conceived the study and is the chair of the UK Association of Children’s Diabetes Clinicians and chair of the NIHR Clinical research Group and Diabetes Research Steering Group for Children and Young People and Guideline Officer for British Society of Paediatric Endocrinology and Diabetes (BSPED). SMN, SD and MF analysed the data and wrote the first draft. All authors reviewed and finalised the paper. SMN and TM are in the BSPED Clinical Committee and TR is Chair of BSPED. SD is the chair of UK CHC and MF is a trustee of UK CHC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.