ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2022) 19 2.3 | DOI: 10.1530/ey.19.2.3

ESPEYB19 2. Antenatal and Neonatal Endocrinology Neonatal hypoglycaemia (8 abstracts)

2.3. Continuous glucose monitoring in the management of neonates with persistent hypoglycemia and congenital hyperinsulinism

Win M , Beckett R , Thomson L , Thankamony A & Beardsall K



J Clin Endocrinol Metab. 2022 Jan 1;107(1):e246-e253. doi: 10.1210/clinem/dgab601. PMID: 34407200.

Brief Summary: This retrospective single center study in neonates with hyperinsulinaemic hypoglycaemia examined the utility of real-time continuous glucose monitoring (CGM). CGM is best placed as an adjunct to routine intermittent blood glucose monitoring, providing information on glucose trends during normoglycemia rather than point accuracy.

Hyperinsulinaemic hyperinsulinism (hyperinsulinism) leads to severe and persistent hypoglycemia. Maintaining normoglycemia in babies with hyperinsulinism can be extremely challenging. Current management strategies involve doing frequent (sometimes hourly) blood sampling, typically heal pricks, in order to detect and treat hypoglycemia. Hourly blood glucose sampling can be stressful for both infants and staff and thus having another method of monitoring glucose levels will be useful.

In this single-center retrospective study the authors assessed the utility of using real-time continuous glucose monitoring (GCM) over a 4-year period in babies with persistent hypoglycemia (these included patients with IUGR and congenital hyperinsulinism babies) concurrent with blood glucose measurements. The study demonstrated that there were marked fluctuations in the CGM readings which made clinical management and prevention of hypoglycaemia challenging when using intermittent blood glucose values. There were high numbers of false-positive CGM readings with limitations in point accuracy.

A previous study also demonstrated high number of false positive hypoglycaemic readings when using GCM in babies with hyperinsulinism (1). Thus, CGM is best placed to act as an adjunct on glucose trends and the timely need for intermittent blood glucose monitoring during normoglycemia rather than point accuracy. The use of CGM to provide reassurance during periods of normoglycemia could potentially limit the need for such frequent blood sampling. The real-time data providing continuous trends that would highlight falling glucose levels and alert the clinician to the need for blood glucose measurement rather than levels simply being taken hourly as part of routine care.

This study also highlighted the need for NICU staff to be trained in using CGM technology which will be critical to using CGM alongside blood glucose monitoring. Newer CGM devices have improved accuracy and no longer require calibration with blood glucose levels but further developments in the technology to optimize use in the newborn would be beneficial.

Reference: 1. Rayannavar A, Elci OU, Mitteer L, De León DD. Continuous glucose monitoring systems: are they useful for evaluating glycemic control in children with hyperinsulinism? Horm Res Paediatr. 2019;92(5):319–327.

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