Diabetes is a chronic disease that is characterized by elevated blood glucose levels.1 There are two types of diabetes mellitus: type 1 and type 2, exemplified by an absolute and relative lack of insulin, respectively. Such dysfunction may lead to hyperglycemia and corresponding complications, including irreversible damage to the eyes, kidneys, nerves, heart, and blood vessels.1 Normal, prediabetic, and diabetic blood glucose levels are found in TABLE 1.2
Epidemiology
Approximately 29.1 million people suffer from diabetes in the United States. It is estimated that 21 million patients are diagnosed and 8.1 million people are undiagnosed. Children are more likely to be diagnosed with type 1 diabetes; however, an increasing number of children have been diagnosed with type 2 diabetes.3 For example, with regard to children, there are approximately 15,000 patients (< 18 years of age) diagnosed with type 1 diabetes per year and 3,700 with type 2 annually. Moreover, the overall incidence of diabetes mellitus in children is approximately 24 cases per 100,000 in the U.S.4
Etiology
Type 1 diabetes usually occurs as a result of genetic susceptibility and, in some cases, may be caused by an unknown environmental trigger.4 In type 1 diabetes, it has been postulated that the autoimmune system attacks the beta cells of the pancreas, the insulin-secreting cells, resulting in a corresponding depletion of insulin. Type 2 diabetes is more common in obese children and in families with a history of this disease.3 The most common cause of obesity in pediatric patients appears to be poor diet and lack of daily physical activity. Children with type 2 diabetes suffer from a relative lack of insulin secretion or from resistance to insulin. Diagnosis of type 2 diabetes in children may be mitigated by early screening, nutritional education, and encouragement to increase activity.
Overview
The Dexcom G4 Platinum (Pediatric) Continuous Glucose Monitoring (CGM) system can reveal data that no other meter can today.5 The only continuous glucose monitor approved for patients aged 2 to 17 years, it provides accurate readings and consistency regarding current glucose levels and intermittent fluctuations. The Dexcom monitor consists of three components: the sensor, transmitter, and the receiver. The sensor measures glucose levels underneath the skin, while the transmitter is fastened right over the sensor and sends the data wirelessly to the receiver. The receiver displays the glucose levels in trends, with different colors to indicate whether the levels are high, normal, or low. The receiver is available in three colors, including ocean blue, classic black, and tickled pink, to fit the preference of the child. The Dexcom monitor provides an alarm when the glucose level falls below 55 mg/dL for an extra measure of awareness.
Efficacy
This device was used previously on patients aged > 18 years. A recent study was performed to evaluate the Dexcom CGM’s efficacy and safety in pediatric patients.6 This study consisted of 176 children aged 2 to 17 years for a 7-day period. Approximately 99% of children had type 1 diabetes and 1% had type 2 diabetes. Glucose levels measured were compared to the Yellow Springs Instrument 2300 STAT Plus Glucose Analyzer (YSI), a reliable laboratory method to accurately measure true blood glucose levels. After a comparison of 2,922 readings from both devices, conclusions support the fact that 55% percent of the Dexcom CGM readings were within 15 mg/dL of the YSI readings.7 It was also reported that 93% of readings were within 40 mg/dL of one another. To this end, the authors concluded that Dexcom CGM was useful in monitoring glucose levels in children. Further, they recommended that this system be employed as an adjunct to a blood glucose meter for accurate results.
Clinical Pearls
The Dexcom G4 Platinum (Pediatric) CGM System is for use as an adjunct to the standard home glucose-monitoring device. Before using the Dexcom device, product instructions should be reviewed. Taking acetaminophen or medications containing acetaminophen while wearing the sensor may falsely raise a patient’s glucose readings owing to the inactive ingredients, such as starch. The device should be calibrated at least every 12 hours. Calibrating less often can cause inaccurate readings and lead to missed hyperglycemic or hypoglycemic events. Children should not be allowed to hold the sensor or transmitter kit, as these elements contain a magnet that is a choking hazard. If an insulin pump is being used in addition to the continuous glucose monitor, the sensor should not be placed within 3 inches of the insulin pump to ensure accuracy. Finally, the transmitter and receiver should not be separated by more than 20 feet. For technical support, patients or caregivers can call 1-877-339-2664 or visit TechSupport@dexcom.com.8
Conclusion
The Dexcom G4 Platinum (Pediatric) CGM System provides consistent, continuous, and accurate readings to test for blood glucose levels. This system is designed with a sensor, a transmitter, and a large receiver that display accurate, easy-to-read results. The Dexcom G4 Platinum (Pediatric) CGM System is a small transportable device that allows results to be transmitted wirelessly. This three-piece monitoring system is an effective solution for patients to monitor their diabetes efficiently.
REFERENCES
1. U.S National Library of Medicine. Diabetes. August 7, 2014. Accessed August 12, 2014.
2. American Diabetes Association. Diagnosing diabetes and learning about pre-diabetes. January 4, 2014. www.diabetes.org. Accessed August 12, 2014.
3. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2014;37:S14-S80.
4. Pediatric type 1 diabetes mellitus. April 27, 2014. Medscape.com. Accessed August 16, 2014.
5. Stay one step ahead of diabetes with Dexcom CGM. Dexcom G4 Platinum for Kids. www.dexcom.com. Accessed August 19, 2014.
6. Effectiveness and safety of the Dexcom G4 Continuous Glucose Monitoring System in pediatric subjects with diabetes mellitus. 2013. www.clinicaltrials.gov. Accessed August 30, 2014.
7. Dexcom G4 Platinum (Pediatric) Continuous Glucose Monitoring System: User’s Guide. 2013. www.dexcom.com. Accessed August 19, 2014.
8. Safety Information-Dexcom. www.dexcom.com. Accessed September 2, 2014.
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