Valentino Cherubini - Glucose Sensor Use in Children and Adolescents: A Practical Guide

Diabetes mellitus is a chronic disease affecting millions of people worldwide. Type 2 diabetes is the most frequent form, involving more than 10% of the population over the age of 50 in some developed countries and it is mainly associated with sedentary habits and obesity. Type 1 diabetes (T1D) represents 510% of the cases of diabetes and affected individuals need insulin therapy right from diagnosis. Type 1 diabetes most commonly affects children and young people as it is diagnosed before the age of 18 in over 50% of cases, thus exposing the subjects to hyperglycemia for several decades. Chronic hyperglycemia , whatever the cause is, inevitably leads to the typical diabetes complications affecting both the microvascular circulation mainly of the retina, the kidneys and peripheral nervous system, and the big vessels, therefore accelerating atherosclerotic processes. Myocardial infarction is the first cause of death in patients suffering from any types of diabetes.

The incidence of T1D is increasing at the rate of about 4% per year, therefore it is estimated that new cases will double in 20 years, with preschool children showing the higher increase in incidence []. At the moment, there is no immediate prospect of a cure and lifelong insulin therapy is required.

One of the main aims of diabetes treatment is to keep blood glucose (BG) levels within a specified range: the desirable target is between 70 and 180 mg/dL, therefore preventing hypoglycemic episodes (glucose <70 mg/dL), as well as prolonged hyperglycemic excursions leading to diabetes complications. If over 60% of time is spent within this target, mean BG is likely to be around 150 mg/dL, equivalent to an HbA1c level of 7% (53 mmol/L). Most international recommendations indicate a value less than 7% as ideal in adults and presently less than 7% also for children [].

The key treatment of T1D consists in balancing insulin doses with food, physical activity, and lifestyle. Starting from the 1980s, BG levels could be measured at home by finger pricking for the first time, which made the link between insulin dose and BG, food, and exercise easier to understand. As a consequence, structured education with empowerment of patients and families became the milestone of diabetes treatment. The appearance of new insulins, both rapid and long-acting analogues, on the market from the 1990s and the introduction of carb-counting techniques from the year 2000, completed the puzzle of the modern treatment to be adopted for every patient with T1D. Basal bolus treatment with insulin analogues or with insulin pumps, associated with carb-counting, is currently the most recommended approach to T1D therapy and management. Despite these recent technological advances, mean HbA1c levels often remain elevated in young patients with T1D []. Psychological factors and the burden of diabetes management may play a role and negatively impact glycemic outcomes.