Op-Med is a collection of original articles contributed by Doximity members.
Dr. Jennifer Sherr presented “Closing the Loop on Managing Youth With Type 1 Diabetes: Children Are Not Just Small Adults” at the 78th Scientific Sessions for the American Diabetes Association(June 22–26) in Orlando, FL.
Doximity discussed the research with Dr. Sherr at ADA 2018. Below is a transcript of the video interview.
Doximity: How do CGM and smart devices hold particular promise and clinical application for youth?
Sherr: I think that the field of technologies is in the midst of a revolution. Our youth are finally able to use them to a greater extent because of all the amazing developments that have gone on. Particularly with sensor therapy, with the use of remote monitoring where parents can follow their child's glucose levels even when they're not with them, it makes a school time so much safer. When the child is away from the family, parents don't need to wake up overnight to test their kid's blood and it's going to allow youth to recognize patterns in their blood sugar levels, so we can go ahead and optimize their insulin doses.
I think that with all of that, we've now been able to have automization of insulin delivery based on that sensor glucose data, and that's the biggest thing that's really going to change for kids. Up until now, the greatest deviation in glycemic control has happened in children, so we set targets according to the American Diabetes Association's standards and our youth had the most suboptimal control. Automating insulin delivery based off of sensor glucose values will allow for more physiologic insulin replacement.
Doximity: What is the future of CGM and smart devices, specifically for youth?
Sherr: Sensor therapies now actually don't require any calibrations. It means that someone can go ahead and insert the device and within a few hours get data throughout their day about their glucose trends.
The devices have longer wear time. In the past where we were requiring our patients to calibrate devices and do things in order to make them work, [now] it's really much more a plug-and-play. That's really what our youths are used to doing in everyday life.
As we build on that_-_and we've seen two devices become available to kids 7–13, [including] the Medtronic 670G pump this past week, and the FDA-approved the t:slim predictive low glucose suspend, which allows for insulin delivery to be suspended and avoid low blood sugars.
It's going to be a game-changer. I think wherein the past parents really had to plead to get kids to adopt these technologies, there's going to be real reasons to adopt them that they'll notice will improve their daily lives.
Doximity: What do other physicians, especially those who don't work with youth, find the most surprising about CGM and smart devices in youth with T1D?
Sherr:How variable their lives are. You know there's a phrase that pediatric providers know well and it's children are not just small adults.
The reason for that is that kids are constantly growing, developing and changing, and so every single day is a new adventure. I think that you know in our current healthcare model we have quarterly visits, [but] that can't keep up with how quickly a child [changes] on a day-to-day basis.
Given that fact, integration of these technologies will really provide us more insight as to what's happening to them on a day to day basis, and allow them to get better care.