Best Practices for Screening and Diagnosis of Type 1 Diabetes in Pediatric Patients - Episode 7
Tina Q. Tan, MD, and Kimberly Simmons, MD, discuss improved methods of monitoring blood glucose levels in patients with type 1 diabetes.
Tina Q. Tan, MD: Can you talk a little bit about the monitoring of individuals who have type 1 diabetes [T1D]? For the longest time, people were doing finger sticks to heck their glucose levels and now there are glucose monitors. Is there anything else coming down the pike that would make it easier for these individuals to get a better idea of what their glucose levels are at any point in time?
Kimberly Simmons, MD: Yes, and are we talking about patients in stage 3 type 1 diabetes?
Tina Q. Tan, MD: Correct. Someone who already has type 1 diabetes.
Kimberly Simmons, MD: This is an area that’s also really exciting, and for people with type 1 diabetes, it’s been life-changing over the last few years. There are now several continuous glucose monitors available, and there are 2 that are available that you do not have to do finger sticks to calibrate. So, you insert the device and the sensors under your skin, and they last from 7 to 14 days based on all 3 that are available. So that’s exciting and really nice for kids when they realize they don’t have to check their fingers 6 to 10 times a day to meet their glycemic targets. They’re very excited to wear these devices. I think that’s been very great.
Then the other thing with diabetes management that’s been really wonderful is hybrid closed-loop artificial pancreas systems. There are several pumps that integrate with the continuous glucose monitors, and there’s some automation of insulin delivery to try to keep glucose levels from going too low or too high. And I think that not only has glycemic control really improved in patients, but we’ve also seen the burden of diabetes decrease, which is very important.
Tina Q. Tan, MD: And with these monitoring systems, are there specific areas of the body where people are supposed to insert them, or can it be worn anywhere?
Kimberly Simmons, MD: When you look at where on the body each sensor is approved to use, it’s based on how they did it during their study. The sites that have been tested in studies are typically the arms, upper buttocks, or abdomen. But, in general, what we see in clinical practice is that you can insert a sensor anywhere where there’s adequate subcutaneous tissue.
Tina Q. Tan, MD: You said that you change the sensor every 7 to 14 days. Is there anything in the works where you don’t have to change the sensor that often? That it can be there a month or 2 months? Because in kids, sometimes it’s really difficult to get them to cooperate when every 1 to 2 weeks they’re getting poked to put this thing back in.
Kimberly Simmons, MD: Yes, so I think the reason that something external can’t stand for longer than a couple of weeks is because the adhesive can’t last any longer, or it’s irritating. I think that’s really the major limitation of having something external. There is a continuous glucose monitor company that’s working on doing implantable sensors. So, there may be something in the future available in the pediatric population that wouldn’t be external, but right now, even the one that’s implanted still has something that’s external on the outside that you wear.
Tina Q. Tan, MD: Are there any activities that kids are not supposed to participate in if they have one of these glucose monitors?
Kimberly Simmons, MD: No. Kids should and can participate in any activity with these glucose monitors. Occasionally, if the activity is contact-related, one could get ripped out, but then you just replace it. We have ways of trying to secure devices and make sure that things are padded, but the device companies have great warranties and can really support families if something were to happen.
Tina Q. Tan, MD: And they can swim with these glucose monitors? Because that’s a question we get all the time. If someone has a line or they have some other external device in place, the big questions are, “Can I take a shower? and “Can I go swimming?”
Kimberly Simmons, MD: Those are great questions. For the continuous glucose monitors, yes, they can be in showers, they can be in the water. For the insulin pumps, there’s a variety, and some are water-resistant but not waterproof. So, for some of them, they have to disconnect them when they go swimming and then reconnect them when they come back out. The other thing is that patients who have waterproof pumps have to also be careful if they’re going in a hot tub, for example, because the insulin, if it gets too hot, cannot work.
Tina Q. Tan, MD: That’s good advice.
Transcript edited for clarity