Experience with Real-Time Continuous Glucose Monitoring in Newborns with Congenital Hyperinsulinemic Hypoglycemia

Abstract

Background Effective treatment and close monitoring of hypoglycemia in children with congenital hyperinsulinemic hypoglycemia (CHH) is vital to prevent brain damage. The current use of capillary sampling schedules does not provide a comprehensive assessment of glycemic status and fails to detect asymptomatic hypoglycemia episodes.

Aim To investigate the efficacy and accuracy of a real-time continuous glucose monitoring system (RT-CGMS) in neonates with CHH.

Methods A sensor connected to RT-CGMS was inserted into the newborn patients and maintained for at least 6 days during their stay in the hospital. We compared the readings of CGMS with capillary blood glucose values using Bland-Altman analysis.

Results A total of 110 blood glucose values were compared to readings from the CGMS. All results were calculated and plotted for CGMS values at 0–4, 5–9, 10–14, 15–19, 20–24, and 25–29 min after capillary blood glucose sampling. CGMS readings were highly correlated with blood glucose values, especially during normoglycemia. In case of hypoglycemia, the mean difference between the CGMS and capillary glucose values was higher. Although the false positive rate for hypoglycemia was relatively high in CGMS, RT-CGMS may show some episodes of hypoglycemia earlier than blood measurement.

Conclusion RT-CGMS is accurate during normoglycemia, and it can reduce the number of capillary blood samples in children with CHH.

Key words

morbidity - neonates - neonatology

Publication History

Received: 22 May 2020

Accepted after revision: 18 June 2020

Article published online:
03 August 2020

• References

• 1 Demirbilek H, Hussain K. Congenital Hyperinsulinism: diagnosis and treatment update. J Clin Res Pediatr Endocrinol 2017; 9: 69-87 doi: 10.4274/jcrpe.2017.S007
• 2 McKinlay CJD, Alsweiler JM, Anstice NS. et al. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr 2017; 171: 972-983 DOI: 10.1001/jamapediatrics.2017.1579.
• 3 Grunau RE, Whitfield MF, Petrie-Thomas J. et al. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants. Pain 2009; 143: 138-146 DOI: 10.1016/j.pain.2009.02.014.
• 4 Harris DL, Battin MR, Weston PJ. et al. Continuous glucose monitoring in newborn babies at risk of hypoglycemia. J Pediatr 2010; 157: e191 DOI: 10.1016/j.jpeds.2010.02.003.
• 5 Mamkin I, Ten S, Bhandari S. et al. Real-time continuous glucose monitoring in the clinical setting: the good, the bad, and the practical. J Diabetes Sci Technol 2008; 2: 882-889 DOI: 10.1177/193229680800200520.
• 6 Mian Z, Hermayer KL, Jenkins A. Continuous glucose monitoring: review of an innovation in diabetes management. Am J Med Sci 2019; 358: 332-339 doi: 10.1016/j.amjms.2019.07.003
• 7 McKinlay CJD, Chase JG, Dickson J. et al. Continuous glucose monitoring in neonates: a review. Matern Health Neonatol Perinatol 2017; 3: 18 DOI: 10.1186/s40748-017-0055-z.
• 8 Guemes M, Hussain K. Hyperinsulinemic hypoglycemia. Pediatr Clin North Am 2015; 62: 1017-1036. doi: 10.1016/j.pcl.2015.04.010
• 9 Gataullina S, De Lonlay P, Dellatolas G. et al. Topography of brain damage in metabolic hypoglycaemia is determined by age at which hypoglycaemia occurred. Dev Med Child Neurol 2013; 55: 162-166. DOI: 10.1111/dmcn.12045.
• 10 Muukkonen L, Mannisto J, Jaaskelainen J. et al. The effect of hypoglycaemia on neurocognitive outcome in children and adolescents with transient or persistent congenital hyperinsulinism. Dev Med Child Neurol 2019; 61: 451-457 DOI: 10.1111/dmcn.14039.
• 11 Worth C, Dunne M, Ghosh A et al. Continuous glucose monitoring for hypoglycaemia in children: perspectives in 2020. Pediatr Diabetes 2020. doi: 10.1111/pedi.13029
• 12 Iglesias Platas I, Thio Lluch M, Pociello Alminana N. et al. Continuous glucose monitoring in infants of very low birth weight. Neonatology 2009; 95: 217-223 DOI: 10.1159/000165980.
• 13 Uettwiller F, Chemin A, Bonnemaison E. et al. Real-time continuous glucose monitoring reduces the duration of hypoglycemia episodes: a randomized trial in very low birth weight neonates. PLoS One 2015; 10: e0116255 DOI: 10.1371/journal.pone.0116255.
• 14 Conrad SC, Mastrototaro JJ, Gitelman SE. The use of a continuous glucose monitoring system in hypoglycemic disorders. J Pediatr Endocrinol Metab 2004; 17: 281-288 doi: 10.1515/jpem.2004.17.3.281
• 15 Rayannavar A, Elci OU, Mitteer L. et al. Continuous glucose monitoring systems: are they useful for evaluating glycemic control in children with hyperinsulinism?. Horm Res Paediatr 2019; 92: 319-327 DOI: 10.1159/000506230.
• 16 McKinlay CJ, Alsweiler JM, Ansell JM. et al. Neonatal glycemia and neurodevelopmental outcomes at 2 years. N Engl J Med 2015; 373: 1507-1518 DOI: 10.1056/NEJMoa1504909.
• 17 Avatapalle HB, Banerjee I, Shah S. et al. Abnormal neurodevelopmental outcomes are common in children with transient congenital hyperinsulinism. Front Endocrinol (Lausanne) 2013; 4: 60 DOI: 10.3389/fendo.2013.00060.
• 18 Cengiz E, Tamborlane WV. A tale of two compartments: interstitial versus blood glucose monitoring. Diabetes Technol Ther 2009; 11 Suppl 1 11-16 DOI: 10.1089/dia.2009.0002.
• 19 Roe JN, Smoller BR. Bloodless glucose measurements. Crit Rev Ther Drug Carrier Syst 1998; 15: 199-241
• 20 Coviello C, Popple Martinez M, Drovandi L. et al. Painful procedures can affect post-natal growth and neurodevelopment in preterm infants. Acta Paediatr 2018; 107: 784-790 DOI: 10.1111/apa.14222.
• 21 Galderisi A, Lago P, Steil GM. et al. Procedural pain during insertion of a continuous glucose monitoring device in preterm infants. J Pediatr 2018; 200: e261-e264 DOI: 10.1016/j.jpeds.2018.03.040.