The Pros of CGMs for Kids (and Parents)
My daughter, Quinn, was diagnosed with type 1 diabetes at the age of 3 and began using an insulin pump in kindergarten at 5. We were slower to come to the continuous glucose monitor (CGM), beginning it in second grade. But just as with her pump, once Quinn began using the CGM, we couldn't imagine diabetes management without this great tool.
The American Diabetes Association's recently released Standards of Medical Care in Diabetes–2013 says that "continuous glucose monitoring (CGM) in conjunction with intensive insulin regimens can be a useful tool to lower A1C in selected adults (aged ≥25 years) with type 1 diabetes. … Although the evidence for A1C lowering is less strong in children, teens, and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device."
It's my opinion that the point of CGM use for some children, from the perspective of parents, may not always be to lower A1C. The value of CGM for parents of young children may not be so easy to measure.
Many children are not able to identify when their blood sugar is dropping, either because they don't feel it or because they are too young to properly express it in words. CGM can help identify low blood sugars either before they occur or, for children who have hypoglycemia unawareness or are not able to express their symptoms, when they occur.
Conversely, the CGM can keep children out of hyperglycemia by notifying us that they are high between meals or overnight. My daughter is often in range before a meal and in range again at the next, but it wasn't until we began using the CGM that we realized she had mountainous blood glucose spikes after breakfast. The CGM is helping us test out strategies to minimize those big swings.
A blood sugar reading given by a meter has no context. When my daughter is 100 mg/dl at bedtime, how do I know if she is dropping, rising, or steady? The CGM gives context to blood sugar numbers to help parents make better decisions about insulin dosing and treating lows.
I think most parents fear what happens—or could happen—overnight to their child with diabetes. The CGM can give parents confidence during the night. Before my daughter used the CGM, I might have let her blood sugar run a little higher than I like at bedtime. I worried that if I corrected it, it might drop too low as she slept. With the CGM, I treat high blood sugars more quickly, with either a correction or an increased temporary basal rate given by her pump, because the CGM is designed to sound an alarm if the blood sugar then begins to drop too low.
And let's talk about sleep. Ask any parent of a child with type 1 diabetes if he or she is well rested. I think most will say no. The CGM allows parents to get a good night's sleep more often because they have peace of mind that its alarm will sound if their child becomes hypoglycemic. That's not to say that I actually sleep through every night. But when I do awake at 2 a.m., I can look at the CGM display on my nightstand and make the decision to get up and go to Quinn's room to check on her or turn back over and, hopefully, fall back asleep.
I have seen my daughter's independence and freedom grow with CGM use. She now has information to use and interpret when she's away from her parents or trained caregivers. She has gone on playdates without us, and her friends' parents have remarked that being able to see the trending arrows on the CGM receiver made them feel much better tasked with her care. Her grandparents feel more confident during sleepovers. This winter Quinn was in a cabaret performance, and I actually left her at practice—without me! She was able to text me her blood sugar and the direction of the CGM arrows during practice.
The CGM is not without problems, including false alarms. There are times when a new sensor is acclimating and awakes me in the night with a low alarm, even though Quinn's blood sugar is perfectly in range. And there are times that a sensor, nearing the end of its run, becomes a bit inaccurate. But there are days and days in between that its accuracy and usefulness are priceless.
The A1C won't measure these advantages of CGM use in children (and I'm sure there are many more), but I have heard many parents say that CGM use has made all the difference in the care of their child with type 1 diabetes.
Is Quinn's A1C lower because of CGM use? I can't say for sure. But I can say that the CGM has given her more freedom and it has given me more confidence to make decisions about her care.
Leighann Calentine is the author of the book Kids First, Diabetes Second and creator of the website D-Mom Blog. Diabetes doesn't keep her daughter, Quinn, 8, from being active in sports and musical theater or just being a regular kid.