The American Diabetes Association recently shared an updated position statement on the management of type 1 diabetes in children and Adolescents. This statement is an update to their previous position statement issued in 2005. Their statement highlights the common sense idea that children are not just mini-adults. Treatment plans for children with Type 1 diabetes need to be tailored to both their current situation and their future growth and development.
The following areas were highlighted in the updated statement of recommendations for children and adolescents with Type 1 Diabetes (T1D):
- Diagnosis of Diabetes
- Blood Glucose Level Management
- Lifestyle Considerations
- Self-Management of Diabetes
- Complications and Comorbidities
- The Transition from Childhood to Adolescence and Adulthood
New Recommendations for Blood Glucose (BG) Management in Children and Adolescents
Most children’s T1D should be treated with insulin regimens with either multiple daily injections or via insulin pump therapy. Healthcare professionals should measure A1C levels of their non-adult patients at 3 month intervals. The target level of A1C should be 7.5 %. Patients or their caregivers should monitor BG levels multiple times a day, typically 6 to 10 times.
Medical devices such as insulin pumps and continuous glucose monitors (CGM) can be very helpful in the management of T1D. The ADA recommends that the CGM be considered in all children and adolescents, even though not using insulin pump therapy. Studies have found that compliant use such devices correlates with better BG control, lower A1C levels and reduction in hypoglycemic events.
Adjunctive Therapies for Children with T1D
One highlight in their recommendations between the management of type 1 diabetes in children versus adults is in regard to adjunctive therapies. They do not recommend the use of adjunctive therapies, such as the medication metformin in children. Clinical trials showed that despite the advantages of such therapies to help with weight loss or other diabetes comorbidities, there are more risks than benefits for children.
Check back next month for our follow-up blog talking about the unique behavioral aspects of managing diabetes in children and adolescents. We’ll focus on the challenges of self-management of their disease and other related health and wellness concerns.
411 on CGM
Exercise for Children with Diabetes
ADA Position Statement
The medical device market is always advancing technologically, as with most other industries. One new technological development, the Continuous Glucose Monitor (CGM), provides added peace of mind to diabetics by providing 24-7 information about blood sugar levels. This constant feedback provided by the device allows for better short and long term control of your diabetes, which will also improve your A1C levels.
The device is comfortable to wear and decreases the number of finger pricks you need to perform daily to check blood sugar. Patients who use a CGM often only need to test their blood sugar twice per day. Two finger pricks per day is much better than the typical number of ten times! This is a huge step forward in diabetes management.
A CGM system includes three components: a sensor, transmitter, and receiver. The sensor inserts into your skin and uses the same enzyme as a test strip (glucose oxidase) to measure blood glucose. The glucose oxidase in the sensor converts the glucose in your blood to hydrogen peroxide, which reacts with the platinum in the sensor. This reaction sends a signal to the transmitter, which inserts into the sensor. The transmitter then communicates with the receiver (or other connected device), notifying you via alerts if your blood sugar is trending high or low. Sensors need to be replaced every seven days.
Here at Active Healthcare, we have a number of patients benefiting from CGM. Our patients appreciate the ability to analyze their blood glucose results and adjust their basal levels accordingly instead of guesstimating from multiple manual tests. We offer two Dexcom systems, the G4 Share and the G5. The G5 is Dexcom’s newest model and pairs with a smartphone or any Apple device, eliminating the need to carry your receiver around. This is especially good for patients who already carry a lot of supplies and devices around to manage their diabetes, such as students. Both systems enable the patient to share device information with up to five other people. We also provide the ongoing supplies for our CGM patients and can send these in the same shipment as your regular diabetic supplies.
Integration with Insulin Pumps
Many insulin pumps are now integrated with CGM including the Animas Vibe and Tandem G4. The newest Tandem pump, the t-slim X2, will have compatibility with this feature later this year. Because the CGM is a complex device, it is recommended that patients get as much information and training as possible both from their physician, diabetic educator, and the various manufacturers before beginning its use.