920-P: Continuous Glucose Monitor Utilization and Adherence in Children with Type 1 Diabetes

Use of continuous glucose monitors (CGM) is associated with lower HbA1c, with the best effect seen for those using the sensor at least 6 of 7 days. Prior studies have shown youth with type 1 diabetes to have poor adherence to CGM use. We aim to evaluate CGM adherence during typical use in our patients with type 1 diabetes.

In this retrospective chart review, the medical records for all patients treated with type 1 diabetes mellitus at the University of Louisville Physicians Pediatric Endocrinology outpatient clinic who initiated CGM use between 2017-2019 were reviewed to determine CGM utilization. CGM use data for patients, ages 2-18 years, was extracted from downloads performed at each clinic visit. Data available for review was 14 or 30 days, determined by receiver type.

During the 2-year study period, CGM was initiated for 253 youth mean age 12 years (SD 3.78). Patients were followed for a mean of 13.4 months (SD 6.7), encompassing 784 follow-up visits (3.1 visits per patient, SD 1.94). Within this time, 64 patients (25%) discontinued use, with a mean of 4.7 months of use (SD 5.4), including 24 patients (9.5%) who received the device and never used it. Of the 190 who initiated CGM use, only 142 (56%) reported current CGM use at each follow-up visit during the study period. Continuous use was associated with younger age at initiation of CGM (p=0.001), shorter duration of diabetes (p=0.005), lower HbA1c (p<0.005), and trial of professional CGM (p=0.001). CGM data was available for 429 of the follow-up visits, with 329 visits (77%) demonstrating the sensor was worn for at least 85% of the preceding 14-30 days.

For youth initiating CGM use during a 2-year period, we found a low rate of adherence to CGM use. However, the majority of those with consistent use wore the sensor at least 6 of 7 days, as recommended for effective use. Factors associated with continuous use included earlier implementation and prior professional CGM trial.