A recent study from Stanford found that pediatric patients with rapid access to continuous glucose monitoring soon after a type 1 diabetes diagnosis had healthier blood sugar values than an earlier group of patients who weren’t given the monitors near the time of diagnosis.
The research provides an example of how the healthcare industry is evolving to use technology: It provides more frequent touchpoints with caregivers, makes quality care available to a larger number of patients, and gives patients of all ages the opportunity to drive their own care.
Specifically, at six months and 12 months after diagnosis, the patients in the new cohort (the group given access to the technology right after diagnosis) had significantly lower and healthier HbA1c levels than the earlier cohort (who received access much later).
The findings show that early access to diabetes technology, combined with structured education and support, leads to positive results for children and adolescent patients. Any time we can use technology to improve outcomes, it is considered a win. However, I believe these findings are much bigger and more impactful from a holistic care perspective.
Reduces a source of tension between kids and parents
Traditional means of measuring blood sugar values require patients to poke their fingers to squeeze a drop of blood, captured by a handheld glucometer. This process takes place multiple times a day and, understandably, presents a potential source of tension between patients and their families. This process can be uncomfortable and often disruptive to a patient’s day.
With continuous glucose monitors, instead of pricking the skin, blood sugar levels are captured through a razor-thin wire that has been placed under the patient’s skin. These wire monitors and sends glucose data to an external device every five minutes, greatly reducing a potential tension point between the child and their parent or caregiver.
This extends beyond the execution of the test as well. With remote monitoring, patients are able to forgo additional or potentially unnecessary trips to the clinic. Not only does this save time, but it keeps the patients in their natural environment and allows them to be engaged in usual activities throughout the day.
This seamless patient experience makes holistic care anywhere a reality and eliminates sources of unwanted stress and burden that can negatively impact outcomes.
Captures how a child’s blood sugar responds to everyday situations
Using the prick-and-capture method of monitoring blood glucose values throughout the day provides only temporary snapshots of the status of the patient, leaving a lot of time in between tests where data is not captured.
By pivoting to a continuous, automated method of capturing this data, a more accurate representation of blood sugar values is provided. Most importantly, the data shows how a patient’s blood sugar values fluctuate throughout the day and how those values respond to everyday situations and activities. This includes, but is not limited to, eating meals, participating in sports, or dealing with possible illness or stressors on the body’s system.
Supports data dashboards allowing medical teams to prioritize help, education or guidance
One of the key learnings that came out of this study was that patients and families were receptive to incorporating this data into electronic medical records. This was important for two reasons.
First, it is much easier for patients to maintain tight glucose control starting soon after they are diagnosed than to try and re-attain those levels once glucose values have increased. Having a constant pulse of data gave patients an active role in education around mitigating diabetes challenges and empowered them to own their health care. The study shows that education and access to technology early in the process drives better results.
Second, having this data automatically uploaded to their electronic medical records meant that care providers could look at patients holistically and determine which individuals and families needed additional education, guidance or support with their care. Not only did this drive a more efficient and effective care team, but it gave patients peace of mind knowing that care providers had visibility into blood sugar values at all times.
It’s worth noting that the transfer of data and the presenting of data in an actionable way can be a challenging prospect. Organizations must understand the engineering and data science requirements that have a critical hand in making device deployment successful.
Coming out of the study, we hope to be able to develop and (eventually) share this dashboard system to help overcome one of the largest barriers to the implementation and adoption of continuous glucose monitoring systems.
What’s next?
As a group of providers, we must work to provide widespread and accessible continuous glucose monitoring capabilities to children and adolescents.
We were pleased with the positive impact that early access to continuous glucose monitoring – and education around the usage and benefits of these solutions – made for children and families.
Part of the success of this study was that all patients were able to participate and benefit from the program equitably, whether they had private or public insurance. This underscores the need to ensure we work collaboratively to overcome potential hurdles, including disparities in accessibility, connectivity and clinician buy-in.
We must continue to advocate for the best possible care for patients. This study proves there are plenty of positives to advocate for.
About David Maahs, MD
Dr. David M. Maahs is the Lucile Salter Packard Professor of Pediatrics, Division Chief of Pediatric Endocrinology, and Associate Chair for Academic Affairs in Pediatrics at Stanford University and the Lucile Packard Children’s Hospital. He earned his MD followed by a Pediatric Residency at the University of New Mexico. After 3 years on New Mexico’s faculty, Dr. Maahs completed a Pediatric Endocrinology fellowship and a concurrent Ph.D. in Epidemiology at the University of Colorado. He remained on Colorado’s faculty for 10 years, advancing to Professor of Pediatrics before moving to Stanford. Prior to his medical career, Dr. Maahs received a BA and MA in English from the University of Kansas and was inspired to pursue a medical career after serving in the Peace Corps with assignments in Tunisia and the Central African Republic.
