{Diabetes Management} ADA’s Standards of Medical Care in Diabetes—2013

by Leighann on January 21, 2013

Last week Wil Dubois, contributor to DiabetesMine discussed several highlights from the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes—2013.

I found much of it to be very interesting and relevant to type 1′s, especially that they suggest that some people may need to test 6-8 times a day. (We test more than that, but that’s a topic for another blog post entirely!) And I’m glad to see more flexible A1c goals.

What really struck me was the discussion about continuous glucose monitor (CGM) use and children.

I began writing a rather lengthy comment, as I always do at DiabetesMine. (I’ve no doubt that as they moderate comments they roll their eyes and think, “Oh geeze. Another long comment from Leighann.”) But I thought it would be best to expand my thoughts here instead.

From DiabetesMine:

The new guidelines state that CGM “can be a useful tool to lower A1C” in folks 25 years old and older, and “may be helpful” in children, teens, and young adults. Why the weaker support for CGMs for kiddos? So far, clinical studies haven’t shown a robust enough improvement in overall control among youth using CGM, but the ADA points out that “the greatest predictor of A1C lowering…was frequency of sensor use, which was lower in younger age-groups.” In other words, if ya’ can get the kid to wear the damn thing, it will work.

As with the test strip issue, I think the Standard’s support for CGM will help knock down the remaining walls to getting CGMs covered for adult type 1s, and provides at least some ammo to help the parents of type 1 kids.

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 is one that may not be so easy to measure. This value includes:

-identifying low blood sugars either before they occur or for children who are hypo unaware or not able to express their symptoms, when they occur

100 Blood Sugar CGM100 Blood Sugar CGM-having context to make better decisions for insulin dosing or treating lows (My child is 100 at bedtime, but is she dropping, rising, or steady?)

-keeping them out of hyperglycemia by notifying us that they are high between meals or overnight

-giving parents confidence overnight, for example, having the confidence to treat a high blood sugar because the CGM will (hopefully) alarm if the child then goes too low

-more frequently allowing parents an entire night’s sleep (a rarity for a parent of a child with diabetes!)

-giving children more independence and freedom by giving them information that they can use and interpret when away from their parents or trained caregivers (It has been very useful for my daughter on play dates)

The A1c won’t measure these advantages of CGM (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.

I hadn’t even considered using a CGM until we had the opportunity to try one out for several months.* And now I can’t imagine managing my daughter’s diabetes without it. In fact when I ask if she would like to take a few days off, she says no.

Is her A1c lower because of CGM use? I don’t know…ask me after our endo appointment next week. 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.

Further Reading

DiabetesMine: Fresh New ADA Standards for You (Yes, Type 1s!)

American Diabetes Association’s (ADA): Standards of Medical Care in Diabetes—2013

More posts about the continuous glucose monitor

*Medtronic Disclosure

All images are copyright D-Mom Blog and D-Mom Media and may not be copied or reproduced without express written permission.

{ 8 comments… read them below or add one }

1 Carol January 21, 2013 at 8:18 am

Definitely agree with you whole- heartedly! Our CGM has also helped me figure out that Casey is extremely insulin sensitive between 2-4am.I now bolus with half the dose.

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2 WilDubois January 21, 2013 at 8:54 am

Leighann—These are all SUPER good points, and all, IMO, more important for kiddos than lower A1Cs. One of the problems with science-based standards is that they can only respond to “hard” science. How do you quantify confidence, independence, freedom? You can’t, at least not by the ways in which clinical science measures “evidence based medicine.” But I think you really hit the nail on the head for CGM for kids: increased safety and improved quality of life for everyone involved!

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3 katy January 21, 2013 at 9:00 am

As one of the people having trouble getting the “kid to wear the damn thing,” I WISH CGM were not considered so optional and extra. I wish our endo (and diabetes society in general) would say, “Look, just like having to test and inject/wear a pump sucks, this sucks, but you have to do it and you’ll get used to it.” Instead CGM is more “You’re lucky your insurance will cover it. It’s a potentially useful tool.”

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4 Kari January 21, 2013 at 7:43 pm

We have been trying unsuccessfully to get our insurance company to approve our child for a CGM. I have been so frustrated because I have had similar thoughts about quality of life for my child and having a tool to take a little bit of the guess work out of this disease. Makes me feel a little more at peace that I’m not crazy and my points are valid!

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5 Leighann January 21, 2013 at 7:52 pm

Have you asked if there is a diabetes case coordinator at your insurance company? We had a lot of paperwork to do, months of BG logs, documented lows, CGM trace, etc. But what we also had to do was have several calls over a certain time period with the diabetes case coordinator. She also helped make sure we had all our ducks in a row.

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6 Linda January 22, 2013 at 6:57 am

Excellent points LeighAnn. I wish all PED Endo’s would be on board with using a GCM. My son’s Ped Endo is not in support of a GCM because she has not seen significant results in kiddo’s using them. However, if the GCM can keep our kiddos in their range, I would think that would be extremely helpful in lowering their A1c’s and should be considered a valuable and insurable tool in managing T1D!

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7 Scott E January 22, 2013 at 5:28 pm

I think your statement about giving parents some piece of mind while the kids are sleeping speaks volumes. It can also be used to “validate” the BG readings that the kids tell you. I know I lied about my readings to my parents quite often when I was younger.

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8 Karen January 23, 2013 at 8:14 am

You nailed it (as usual:))! We have had the CGM for 3 1/2 weeks and already I wonder why this VALUABLE tool is not prescribed AT diagnosis. And ESPECIALLY for children!! The ability to know not only where they are but which way and how fast they are going is not only useful…it is flat-out NECESSARY in making treatment decisions. And yes, I sleep better. And yes, I panic a bit less when she is away from me. Freedom and confidence cannot be measured. AND…her fingers are better:) We were testing 10-14 times a day. Now it is half that. We have the Dexcom G4 and it is SPOT-ON accurate. We test before meals and to verify a high or low before treatment…because that is what we are told to do. But the meter always confirms the CGM reading…sometimes exactly, almost always within 10 points. Thankfully we had no trouble at all getting our insurance to cover it.

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