{"title":"持续血糖监测在儿童全胰腺切除术和胰岛自体移植人群中的局限性：Dexcom和FreeStyle Libre系统的患者经验比较。","authors":"Bhavapriya Mani, Lindsey Hornung, Chelsie Fellman, Maisam Abu El-Haija, Siobhan Tellez, Deborah Elder","doi":"10.2337/ds24-0073","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Continuous glucose monitoring (CGM) systems reduce self-monitoring burden compared with glucose meter use but have limitations when used after total pancreatectomy with islet autotransplantation (TPIAT). An example is false elevation of sensor readings after hydroxyurea (HU) administration, a medication often used after TPIAT. This study compared user experiences of CGM not affected by HU with CGM affected by HU in pediatric patients post-TPIAT.</p><p><strong>Research design and methods: </strong>This was a retrospective study of 20 TPIAT patients. Caregivers were informed of known limitations and chose the CGM system for postoperative use. Ten chose a Dexcom, and 10 chose a FreeStyle Libre CGM system. Demographic data and caregiver-reported CGM concerns were collected up to 16 weeks after discharge.</p><p><strong>Results: </strong>Half of Dexcom users reported false hypoglycemia alerts that resolved with repositioning, recalibration, or sensor change. False hyperglycemia was an anticipated outcome and therefore not reported as concerning. Eight FreeStyle Libre users reported false hypoglycemia and frequent alarms that persisted despite sensor changes, which limited device supply. These concerns could not be independently resolved, contributed to caregiver distress, and interrupted sleep. More FreeStyle Libre patients switched to Dexcom than Dexcom patients who switched to a FreeStyle Libre system (70 vs. 10%, <i>P</i> = 0.02) by a median of 2.9 weeks after discharge.</p><p><strong>Conclusion: </strong>Caregivers reported frequent false alarms on both systems. The frequency of false hypoglycemia with FreeStyle Libre was an unexpected limitation with an unclear cause. The inability to calibrate the FreeStyle Libre likely contributed to frequent sensor changes and supply depletion. The ability to recalibrate the Dexcom system may provide an advantage, but not for people taking HU. Knowledge of CGM limitations post-TPIAT can help individuals make informed decisions.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":"38 3","pages":"300-306"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357206/pdf/","citationCount":"0","resultStr":"{\"title\":\"Limitations of Continuous Glucose Monitoring in the Pediatric Total Pancreatectomy With Islet Autotransplantation Population: Comparing Patient Experiences of the Dexcom and FreeStyle Libre Systems.\",\"authors\":\"Bhavapriya Mani, Lindsey Hornung, Chelsie Fellman, Maisam Abu El-Haija, Siobhan Tellez, Deborah Elder\",\"doi\":\"10.2337/ds24-0073\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Continuous glucose monitoring (CGM) systems reduce self-monitoring burden compared with glucose meter use but have limitations when used after total pancreatectomy with islet autotransplantation (TPIAT). An example is false elevation of sensor readings after hydroxyurea (HU) administration, a medication often used after TPIAT. This study compared user experiences of CGM not affected by HU with CGM affected by HU in pediatric patients post-TPIAT.</p><p><strong>Research design and methods: </strong>This was a retrospective study of 20 TPIAT patients. Caregivers were informed of known limitations and chose the CGM system for postoperative use. Ten chose a Dexcom, and 10 chose a FreeStyle Libre CGM system. Demographic data and caregiver-reported CGM concerns were collected up to 16 weeks after discharge.</p><p><strong>Results: </strong>Half of Dexcom users reported false hypoglycemia alerts that resolved with repositioning, recalibration, or sensor change. False hyperglycemia was an anticipated outcome and therefore not reported as concerning. Eight FreeStyle Libre users reported false hypoglycemia and frequent alarms that persisted despite sensor changes, which limited device supply. These concerns could not be independently resolved, contributed to caregiver distress, and interrupted sleep. More FreeStyle Libre patients switched to Dexcom than Dexcom patients who switched to a FreeStyle Libre system (70 vs. 10%, <i>P</i> = 0.02) by a median of 2.9 weeks after discharge.</p><p><strong>Conclusion: </strong>Caregivers reported frequent false alarms on both systems. The frequency of false hypoglycemia with FreeStyle Libre was an unexpected limitation with an unclear cause. The inability to calibrate the FreeStyle Libre likely contributed to frequent sensor changes and supply depletion. The ability to recalibrate the Dexcom system may provide an advantage, but not for people taking HU. Knowledge of CGM limitations post-TPIAT can help individuals make informed decisions.</p>\",\"PeriodicalId\":39737,\"journal\":{\"name\":\"Diabetes Spectrum\",\"volume\":\"38 3\",\"pages\":\"300-306\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357206/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diabetes Spectrum\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2337/ds24-0073\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes Spectrum","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2337/ds24-0073","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的：与使用血糖仪相比，连续血糖监测（CGM）系统减轻了自我监测负担，但在全胰切除术合并胰岛自体移植（TPIAT）后使用该系统存在局限性。一个例子是羟基脲（HU）给药后传感器读数的假升高，羟基脲是TPIAT后常用的一种药物。本研究比较了tpiat后儿科患者未受HU影响的CGM与受HU影响的CGM的用户体验。研究设计与方法：对20例TPIAT患者进行回顾性研究。护理人员被告知已知的局限性，并选择术后使用CGM系统。10人选择了Dexcom， 10人选择了FreeStyle Libre CGM系统。在出院后16周收集人口统计数据和护理人员报告的CGM问题。结果：一半的Dexcom用户报告了错误的低血糖警报，这些警报通过重新定位、重新校准或更换传感器来解决。假性高血糖是预期的结果，因此未作为相关报道。8名FreeStyle Libre用户报告称，尽管更换了传感器，他们仍然出现了错误的低血糖和频繁的警报，这限制了设备的供应。这些担忧不能独立解决，导致照顾者痛苦，并中断睡眠。出院后2.9周，改用Dexcom系统的FreeStyle Libre患者比改用FreeStyle Libre系统的Dexcom患者多（70 vs. 10%, P = 0.02）。结论：护理人员报告了两个系统频繁的假警报。自由式低血糖的频率是一个意外的限制，原因不明。无法校准FreeStyle Libre可能导致传感器频繁更换和供应枯竭。重新校准Dexcom系统的能力可能会提供一个优势，但对于使用HU的人来说并非如此。了解tpiat后CGM的局限性可以帮助个人做出明智的决定。
Limitations of Continuous Glucose Monitoring in the Pediatric Total Pancreatectomy With Islet Autotransplantation Population: Comparing Patient Experiences of the Dexcom and FreeStyle Libre Systems.
Objective: Continuous glucose monitoring (CGM) systems reduce self-monitoring burden compared with glucose meter use but have limitations when used after total pancreatectomy with islet autotransplantation (TPIAT). An example is false elevation of sensor readings after hydroxyurea (HU) administration, a medication often used after TPIAT. This study compared user experiences of CGM not affected by HU with CGM affected by HU in pediatric patients post-TPIAT.
Research design and methods: This was a retrospective study of 20 TPIAT patients. Caregivers were informed of known limitations and chose the CGM system for postoperative use. Ten chose a Dexcom, and 10 chose a FreeStyle Libre CGM system. Demographic data and caregiver-reported CGM concerns were collected up to 16 weeks after discharge.
Results: Half of Dexcom users reported false hypoglycemia alerts that resolved with repositioning, recalibration, or sensor change. False hyperglycemia was an anticipated outcome and therefore not reported as concerning. Eight FreeStyle Libre users reported false hypoglycemia and frequent alarms that persisted despite sensor changes, which limited device supply. These concerns could not be independently resolved, contributed to caregiver distress, and interrupted sleep. More FreeStyle Libre patients switched to Dexcom than Dexcom patients who switched to a FreeStyle Libre system (70 vs. 10%, P = 0.02) by a median of 2.9 weeks after discharge.
Conclusion: Caregivers reported frequent false alarms on both systems. The frequency of false hypoglycemia with FreeStyle Libre was an unexpected limitation with an unclear cause. The inability to calibrate the FreeStyle Libre likely contributed to frequent sensor changes and supply depletion. The ability to recalibrate the Dexcom system may provide an advantage, but not for people taking HU. Knowledge of CGM limitations post-TPIAT can help individuals make informed decisions.
期刊介绍：
The mission of Diabetes Spectrum: From Research to Practice is to assist health care professionals in the development of strategies to individualize treatment and diabetes self-management education for improved quality of life and diabetes control. These goals are achieved by presenting review as well as original, peer-reviewed articles on topics in clinical diabetes management, professional and patient education, nutrition, behavioral science and counseling, educational program development, and advocacy. In each issue, the FROM RESEARCH TO PRACTICE section explores, in depth, a diabetes care topic and provides practical application of current research findings.
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