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Introduction Although continuous glucose monitoring (CGM) has increased in patients with Type 1 diabetes, its use in the neonatal population has remained limited. Neonates, particularly preterm infants, are at risk of impaired glucose control. Several studies have looked at the use of these devices in improving care for premature infants without diabetes. We describe a case of a very low birth infant with neonatal diabetes secondary to a GATA-6 mutation. Clinical Case This is a late preterm infant with IUGR, truncus arteriosus, and neonatal diabetes. Exome genetic panel showed a mutation in GATA-6. Her neonatal diabetes was challenging to control due to variable blood sugars and sensitivity to insulin. Weight gain remained poor. A CGM (Dexcom G6) was placed when the infant was 1.59kg to optimize her diabetes management and improve weight gain. An insulin titration chart was used to adjust her IV regular insulin infusion according to the CGM glucose levels and trend arrows. The following outcomes were reviewed and analyzed fourteen days before and after CGM placement: glucose levels (238 vs. 177 mg/dL), percentage of glucose levels within target range of 70-180mg/dL (31% vs 51%), average number of daily POC glucose checks (10.2 vs. 6.9), average amount of insulin received per day (0.42 vs 0.52 units/day), and average weight gain (11.4 vs. 20.7 grams/day). The discrepancy between POC and CGM glucose was also analyzed. CGM was within 20% of POC values 44% of the time and within 30% POC values 70% of the time. Adverse side effects of CGM were also noted. The patient was started on antibiotics following a small abscess identified underneath the CGM site. Bruising and skin breakdown were noted at the site, and the patient completed a course of antibiotics for the cutaneous infection. There were no other concerns of infection related to CGM for the first 2.5 months following CGM placement. Conclusion This case highlights that CGM can effectively be used to optimize glucose management in neonatal diabetes in a very low birth weight infant. However, the area where the CGM is placed needs to be monitored for signs of infection. The use of continuous glucose monitoring (CGM) in newborn infants has remained limited even though newborn infants are at risk of impaired glucose control. We describe a case of a very low birth weight infant with neonatal diabetes in which a CGM was placed. Following placement of a CGM, average glucose levels were lower, the average amount of insulin received per day was increased, and average weight gain per day improved. Adverse side effects included infection at the site of the CGM. This case highlights that CGM can be used to optimize glucose management in neonatal diabetes.
Endocrinology, Diabetes, and Metabolism | Pediatrics
Metzinger, Emily and Halpin, Kelsee, "Use of CGM in Monitoring Neonatal Diabetes" (2022). Posters. 287.