Glucose Sensor Use in Children and Adolescents: A Practical Guide [1st ed.] 9783030428051, 9783030428068

Citation preview

Glucose Sensor Use in Children and Adolescents A Practical Guide Valentino Cherubini Daniela Elleri Stefano Zucchini Editors

123

Glucose Sensor Use in Children and Adolescents

Valentino Cherubini Daniela Elleri  •  Stefano Zucchini Editors

Glucose Sensor Use in Children and Adolescents A Practical Guide

Editors

Valentino Cherubini Department of Women’s and Children’s Health Azienda OspedalieroUniversitaria Ospedali Riuntiti Ancona, “G. Salesi” Hospital Ancona, Italy

Daniela Elleri Endocrine/Diabetes Department Royal Hospital for Sick Children Edinburgh, UK

Stefano Zucchini Pediatric Endocrine Unit Department of Woman Child and Urologic Diseases S.Orsola-Malpighi Hospital Bologna, Italy

ISBN 978-3-030-42805-1    ISBN 978-3-030-42806-8 (eBook) https://doi.org/10.1007/978-3-030-42806-8 © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface

Technology is nowadays an integrated part of day-to-day diabetes management, and an increasing number of patients are currently using continuous glucose monitoring (CGM) devices and smart insulin pumps. Over the last few decades, significant progress has been achieved in terms of systems’ performance and convenience of use. Manufacturers are continuing to update existing technologies so that new devices are regularly becoming available on the market. Both patients and healthcare professionals must therefore keep up-to-date with these technological advances to provide the best care. The suboptimal performance of the first CGM devices has initially been seen as the weakest link in the development of closed loop systems, but the latest CGM models have improved and reached sufficient accuracy to allow the development of semi-intelligent insulin pumps. Children’s diabetes care has specific challenges including greater glucose variability, hypoglycemia unawareness, and other unpredictable factors such as variable eating patterns. For these reasons, children may get the greatest benefit from the use of technology. This booklet represents a practical guide in explaining how CGM devices work, their use in children with type 1 diabetes, their benefits, and possible pitfalls. The booklet also contains several practical pictures, which would hopefully help getting familiar with the use of different types of devices. The authors of this booklet have longstanding clinical experience in caring for children with diabetes and c­ ontributed

vi

Preface

to the scientific knowledge in the field. The booklet is aimed at all caregivers willing to develop a practical knowledge on currently available CGM devices used in children with type 1 diabetes. Ancona, Italy Edinburgh, UK  Bologna, Italy 

Valentino Cherubini Daniela Elleri Stefano Zucchini

Contents

1 Introduction on Use of Technology in Pediatric Type 1 Diabetes�����������������������������������������������  1 Stefano Zucchini 2 The Technology of Glucose Sensors �����������������������������  7 Chetty Tarini 3 Different Types of Continuous Glucose Monitoring Systems on the Market����������������������������������������������������� 13 Giulio Maltoni and Stefano Zucchini 4 Clinical Studies on Efficacy of Continuous Glucose Monitoring������������������������������������������������������������������������� 35 Valentino Cherubini 5 Sensor Use in Toddlers and Pre-school Children��������� 49 Chetty Tarini 6 Continuous Glucose Monitoring (CGM) Use in Adolescents������������������������������������������������������������������� 57 Daniela Elleri 7 Unexpected Highs and Lows������������������������������������������ 63 Giulio Maltoni 8 How to Insert and Wear CGM��������������������������������������� 73 Anna Maria Paparusso

viii

Contents

9 Pitfalls in the Use of Continuous Glucose Monitoring������������������������������������������������������������������������� 79 Daniela Elleri 10 Psychological Issues��������������������������������������������������������� 85 Maria Cristina Alessandrelli 11 Conclusions����������������������������������������������������������������������� 91 Valentino Cherubini Index������������������������������������������������������������������������������������������� 95

Chapter 1 Introduction on Use of Technology in Pediatric Type 1 Diabetes Stefano Zucchini Diabetes mellitus is a chronic disease affecting millions of people worldwide. Type 2 diabetes is the most frequent form, involving more than 10% of the population over the age of 50  in some developed countries and it is mainly associated with sedentary habits and obesity. Type 1 diabetes (T1D) represents 5–10% of the cases of diabetes and affected individuals need insulin therapy right from diagnosis. Type 1 diabetes most commonly affects children and young people as it is diagnosed before the age of 18 in over 50% of cases, thus exposing the subjects to hyperglycemia for several decades. Chronic hyperglycemia, whatever the cause is, inevitably leads to the typical diabetes complications affecting both the microvascular circulation mainly of the retina, the kidneys and peripheral nervous system, and the big vessels, therefore accelerating atherosclerotic processes. Myocardial infarction is the first cause of death in patients suffering from any types of diabetes. The incidence of T1D is increasing at the rate of about 4% per year, therefore it is estimated that new cases will double in 20  years, with preschool children showing the higher S. Zucchini (*) Pediatric Endocrine Unit, Department of Woman Child and Urologic Diseases, S. Orsola-Malpighi Hospital, Bologna, Italy e-mail: [email protected] © Springer Nature Switzerland AG 2020 V. Cherubini et al. (eds.), Glucose Sensor Use in Children and Adolescents, https://doi.org/10.1007/978-3-030-42806-8_1

1

2

S. Zucchini

increase in incidence [1]. At the moment, there is no immediate prospect of a cure and lifelong insulin therapy is required. One of the main aims of diabetes treatment is to keep blood glucose (BG) levels within a specified range: the desirable target is between 70 and 180 mg/dL, therefore preventing hypoglycemic episodes (glucose