Remote Glucose Monitoring in Diabetes Eases Parents' Fears

Miriam E. Tucker

November 14, 2018

The ability for parents of children with type 1 diabetes to remotely monitor their children's glucose levels goes a long way toward easing parental anxiety, new research suggests.

Results from the first-ever study powered to specifically examine parental psychosocial outcomes as a primary endpoint with the use of remote continuous glucose monitoring (CGM) were recently published in Diabetes Care by Marie-Anne Burckhardt, MD, Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, and colleagues.

"CGM with remote monitoring reduces fear of hypoglycemia and improves other psychosocial metrics in parents of children with type 1 diabetes. Use of such systems has the potential to reduce the disease burden for those families," Burckhardt and colleagues write.

CGM Cuts Parental Fear of Hypoglycemia and Stress, Improves Sleep

The randomized crossover study included 49 children aged 2 to 12 years with type 1 diabetes and their parents. None had used CGM in the prior 6 months. At the time of the study, CGM was not publicly funded in Australia and usage was low, the authors note.

Twenty-nine children (64%) used an insulin pump. Remote monitoring was used by 48 (98%) parents; 35 children (73%) had more than one follower, mostly both parents.

Each participant spent 3 months using conventional blood glucose monitoring and another 3 months (with 2-month washouts in between) using the Dexcom G5 Mobile CGM system with remote monitoring, which allows transmission of sensor glucose values via Bluetooth to a mobile phone or other device.

This information can be shared with up to five designated people who can remotely monitor the user's glucose in real time. For all the children, the low alert of the CGM was set at 4.0 mmol/L (72 mg/dL).

Parents filled out questionnaires at baseline and after each 3-month period.

The primary outcome, parental fear of hypoglycemia score assessed by the Hypoglycemia Fear Survey, was significantly lower following the remote monitoring period than after the control period (from baseline mean 54.9 to 44.7 versus 53.2 for controls; P < .001). Results for the individual behavior and worry subscales were similarly significant.

Quality of life, assessed by parent proxy report on the Family Impact Module of the Pediatric Quality of Life Inventory (PedsQL), was also significantly improved following the remote monitoring period compared with the control period (P = .002), as were the subscales of parental health-related quality of life (P = .003) and family functioning (P = .005).

However, there were no significant differences in general and diabetes-specific quality of life on the PedsQL (P = .150 and .066, respectively).

Other significant improvements following remote monitoring were lower parental stress levels on the Depression Anxiety Stress Scale (P = .005), both state and trait anxiety on the State and Trait Anxiety Inventory (P = .014 and P < .001, respectively), and improved parental sleep, as measured by the Pittsburgh Sleep Quality Index (P =  .02).

However, there were no differences in mean HbA1c of the pediatric patients after the remote monitoring versus control periods (both HbA1c 7.8%).

"This could be attributed to the fact that there was no active effort to improve diabetes management in this study group since the purpose of this trial was to determine the efficacy of the CGM system to improve quality of life metrics," Burckhardt and colleagues say. 

The study was performed at the Children's Diabetes Centre in Perth, a center of research excellence funded by the JDRF/National Health and Medical Research Council. Burckhardt has reported receiving research fellowships from the Swiss National Science Foundation and Walter and Margarete Lichtenstein Foundation of the University of Basel, Switzerland, and was supported by the research training program of the University of Western Australia. Dexcom provided the sensors and hardware through an unrestricted grant.

Diabetes Care. Published online October 30, 2018. Abstract

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