Sydney Diabetes centre's experience of the Australian Government's roll out of subsidised continuous glucose monitoring for children with type 1 diabetes mellitus

Jessica L Sandy; Ohn Nyunt; Helen J Woodhead; Lesley S Youde; Kim A Ramjan; Michelle M Jack; Lena Lim; Margaret Shepherd; Ailsa Marshall; Nicky Townsend; Suzi Wilson; Sally-Anne Duke; Eve Slavich; Shihab Hameed

doi:10.1111/jpc.14340

Sydney Diabetes centre's experience of the Australian Government's roll out of subsidised continuous glucose monitoring for children with type 1 diabetes mellitus

J Paediatr Child Health. 2019 Sep;55(9):1056-1062. doi: 10.1111/jpc.14340. Epub 2018 Dec 19.

Authors

Jessica L Sandy^{1

2}, Ohn Nyunt^{1

2

3}, Helen J Woodhead^{1

2}, Lesley S Youde¹, Kim A Ramjan^{1

4

5}, Michelle M Jack^{1

3}, Lena Lim¹, Margaret Shepherd¹, Ailsa Marshall¹, Nicky Townsend¹, Suzi Wilson¹, Sally-Anne Duke^{3

6}, Eve Slavich⁷, Shihab Hameed^{1

2

3}

Affiliations

¹ Department of Paediatric Diabetes and Endocrinology, Clinical Services Building, Royal North Shore Hospital, Sydney, New South Wales, Australia.
² Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
³ Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.
⁴ Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁵ School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
⁶ Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
⁷ Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, New South Wales, Australia.

PMID: 30565355
DOI: 10.1111/jpc.14340

Abstract

Aim: To determine patient/carer expectations of continuous glucose monitoring (CGM) and short-term satisfaction, to assess the efficacy of CGM in improving: fear of hypoglycaemia and glycaemic control (HbA_1c , ketosis, hypoglycaemia) and to determine time requirements of diabetes clinic staff in commencing and administering CGM.

Methods: We assessed CGM-naïve patients starting on CGM at a Sydney Diabetes Centre following the introduction of a nationwide government subsidy for CGM. A standardised questionnaire was administered collecting demographic and glycaemic information in addition to Likert scale assessment of expectations and satisfaction. Clinic staff reported time dedicated to CGM education, commencement and follow-up.

Results: A total of 55 patients or parents/carers completed baseline questionnaires, with 37 completing a 3-month follow-up questionnaire. There were high expectations of CGM prior to commencement and high satisfaction ratings on follow-up. CGM improved fear of hypoglycaemia, and total daily insulin dose increased after commencement of CGM. There was a trend towards lower HbA_1c that was not statistically significant and no statistically significant reduction in ketosis or hypoglycaemia. Comments were mostly positive, with some concern raised regarding technical issues and a lack of subsidy after 21 years of age. Staff time requirements were substantial, with an estimated average of 7.7 h per patient per year.

Conclusions: Patients and families have high expectations of CGM, and satisfaction levels are high in the short term. Total insulin delivery increased after CGM commencement. Time requirements by staff are substantial but are worthwhile if families' overall satisfaction levels are high.

Keywords: ambulatory; blood glucose self-monitoring; child; diabetes mellitus; insulin infusion system; monitoring.

MeSH terms

Adolescent
Ambulatory Care
Blood Glucose Self-Monitoring*
Child
Diabetes Mellitus, Type 1*
Fear
Female
Government Programs*
Humans
Hypoglycemia / psychology
Insulin Infusion Systems
Male
New South Wales
Patient Satisfaction
Surveys and Questionnaires
Young Adult