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.
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
-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.
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
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