Conference abstract
Continuous glucose monitoring in type 1 diabetes mellitus among children and youth in Uganda
Pan African Medical Journal - Conference Proceedings. 2021:11(35).01
Feb 2021.
doi: 10.11604/pamj-cp.2021.11.35.1011
Archived on: 01 Feb 2021
Contact the corresponding author
Keywords: Continuous glucose monitoring, diabetes, children, Uganda
Oral presentation
Continuous glucose monitoring in type 1 diabetes mellitus among children and youth in Uganda
Thereza Piloya-Were1,&, Lauren Mcclure2, Geofrey Ojilong3, Lucy Mungai4, Antoinette Moran2
1Department of Pediatrics, Makerere University, Kampala, Uganda, 2Department of Pediatrics, University of Minnesota, USA, 3Mulago National Referral Hospital, Kampala, Uganda, 4Department of Pediatrics, University of Nairobi, Kenya
&Corresponding author
Introduction: glycemic control is important in management of type 1 diabetes (T1DM) to prevent long term complications. The ISPAD guidelines recommend HBA1c% target < 7.5 as an indicator for good glycemic control. This target is challenging for majority of patients. Children with diabetes, in particular, face unique challenges; young children may be unaware of hypoglycaemic spells so unable to communicate or treat low sugars. Further still, in RLS children may be unable to check their blood glucose multiple times to make decisions on their dose adjustments. Therefore, continuous glucose monitor (CGM) has a unique role in children and opportunities in the RLS population. This study was to determine the baseline 10 -14 days of 24 hour glucose patterns as measured by libre pro CGM of T1DM patients and to describe their experience while using the CGM sensor. Methods: this was a pilot study for glucose variability among T1DM Ugandans with established DM. It was a prospective study for two weeks for children and youth ages 1 - 26 years attending the Mulago Regional referral hospital DM clinic in the month of November - December 2018. Written informed Consent and assent was obtained from the participants. A libre- pro CGM sensor was placed on the participants for 10 -14 days. The glucose data was retrieved using the Libreview software including average glucose, percentage in range, percentage in hypoglycemia, percentage in hyperglycemia and glucose variability. Other variables included: HbA1c, age, BMI, duration of diabetes, usual insulin type and dose, usual number of test strips used per week, and any severe hypoglycemia in the preceding 3 months. Results: sixty of the 62 participants enrolled had sensor data analysed. The median age of participants was 17 years (range 4- 25), 55% female and with a mean DM duration of 7.2 (SD 4.6). Majority (65%) of the participants were on premixed insulin on a mean dose of 0.900IU/kg/day (SD 0.264). The mean HBA1c% was 10.46 with 13 (21.7%) of 60 participants in glycemic target. The mean duration of CGM recording was 14 days .The mean 14-day glucose was 239mg/dl (SD 84.08) with 52% and 3.5% of the participants having more than 60% of the time above 180mg/dl and below 70mg/dl respectively. Only 22 (38.6%) of 60 participants had their blood glucose in target for 30- 60% of the time. The mean hypoglycemic events recorded were 12(SD 9.5) with more than half (52.8%) having more than 10 events recorded but only 15 (25%) of 60 participants reported severe hypoglycaemic events in the last 1 year. Majority of the recorded hypoglycaemic events occurred at night. More than half (58.2%) of the participants reported no pain at all during insertion of the sensor compared to 15% with finger pricks. More than 85% felt it did not make routine activity hard and 76% felt it was not difficult maintaining the sensor while only 69% felt it was easy doing glucose tests. Majority (81%) felt that the CGM will improve DM management. Conclusion: Children and youth with T1DM in Ugandan clinic have high mean blood glucose and many hypoglycaemic events. CGM was acceptable and feasible for children in Resource Limited Settings.
Continuous glucose monitoring in type 1 diabetes mellitus among children and youth in Uganda
Thereza Piloya-Were1,&, Lauren Mcclure2, Geofrey Ojilong3, Lucy Mungai4, Antoinette Moran2
1Department of Pediatrics, Makerere University, Kampala, Uganda, 2Department of Pediatrics, University of Minnesota, USA, 3Mulago National Referral Hospital, Kampala, Uganda, 4Department of Pediatrics, University of Nairobi, Kenya
&Corresponding author
Introduction: glycemic control is important in management of type 1 diabetes (T1DM) to prevent long term complications. The ISPAD guidelines recommend HBA1c% target < 7.5 as an indicator for good glycemic control. This target is challenging for majority of patients. Children with diabetes, in particular, face unique challenges; young children may be unaware of hypoglycaemic spells so unable to communicate or treat low sugars. Further still, in RLS children may be unable to check their blood glucose multiple times to make decisions on their dose adjustments. Therefore, continuous glucose monitor (CGM) has a unique role in children and opportunities in the RLS population. This study was to determine the baseline 10 -14 days of 24 hour glucose patterns as measured by libre pro CGM of T1DM patients and to describe their experience while using the CGM sensor. Methods: this was a pilot study for glucose variability among T1DM Ugandans with established DM. It was a prospective study for two weeks for children and youth ages 1 - 26 years attending the Mulago Regional referral hospital DM clinic in the month of November - December 2018. Written informed Consent and assent was obtained from the participants. A libre- pro CGM sensor was placed on the participants for 10 -14 days. The glucose data was retrieved using the Libreview software including average glucose, percentage in range, percentage in hypoglycemia, percentage in hyperglycemia and glucose variability. Other variables included: HbA1c, age, BMI, duration of diabetes, usual insulin type and dose, usual number of test strips used per week, and any severe hypoglycemia in the preceding 3 months. Results: sixty of the 62 participants enrolled had sensor data analysed. The median age of participants was 17 years (range 4- 25), 55% female and with a mean DM duration of 7.2 (SD 4.6). Majority (65%) of the participants were on premixed insulin on a mean dose of 0.900IU/kg/day (SD 0.264). The mean HBA1c% was 10.46 with 13 (21.7%) of 60 participants in glycemic target. The mean duration of CGM recording was 14 days .The mean 14-day glucose was 239mg/dl (SD 84.08) with 52% and 3.5% of the participants having more than 60% of the time above 180mg/dl and below 70mg/dl respectively. Only 22 (38.6%) of 60 participants had their blood glucose in target for 30- 60% of the time. The mean hypoglycemic events recorded were 12(SD 9.5) with more than half (52.8%) having more than 10 events recorded but only 15 (25%) of 60 participants reported severe hypoglycaemic events in the last 1 year. Majority of the recorded hypoglycaemic events occurred at night. More than half (58.2%) of the participants reported no pain at all during insertion of the sensor compared to 15% with finger pricks. More than 85% felt it did not make routine activity hard and 76% felt it was not difficult maintaining the sensor while only 69% felt it was easy doing glucose tests. Majority (81%) felt that the CGM will improve DM management. Conclusion: Children and youth with T1DM in Ugandan clinic have high mean blood glucose and many hypoglycaemic events. CGM was acceptable and feasible for children in Resource Limited Settings.
