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CGM Metrics Identify Dysglycemic States in Subjects from the TrialNet Pathway to Prevention Study

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posted on 2023-02-01, 19:52 authored by Darrell M. Wilson, Susan L. Pietropaolo, Maria Acevedo-Calado, Shuai Huang, Destiny Anyaiwe, David Scheinker, Andrea K. Steck, Madhuri M. Vasudevan, Siripoom V. McKay, Jennifer L. Sherr, Kevan C. Herold, Jessica L. Dunne, Carla J. Greenbaum, Sandra M. Lord, Michael J. Haller, Desmond A. Schatz, Mark A. Atkinson, Patrick W. Nelson, Massimo Pietropaolo, Type 1 Diabetes TrialNet Study Group

  

OBJECTIVE 

Continuous glucose monitoring (CGM) parameters may identify subjects at risk of progressing to overt type 1 diabetes. We aimed to determine whether CGM metrics provides additional insights into progression to clinical Stage 3 type 1 diabetes. 

RESEARCH DESIGN AND METHODS 

One hundred and five relatives of type 1 diabetes probands (median age 16.8 years; 89% non-Hispanic White; 43.8% female) from the TrialNet Pathway to Prevention Study underwent 7-day CGM assessments and oral glucose tolerance tests (OGTTs) at 6-month intervals, the baseline data is reported here. Three groups were evaluated: individuals with 1) Stage 2 type 1 diabetes (n=42) with ≥2 diabetes-related autoantibodies and abnormal OGTT; 2) Stage 1 type 1 diabetes (n=53) with ≥2 diabetes-related autoantibodies and normal OGTT; and 3) negative test for all diabetes-related autoantibodies and normal OGTT (n=10). 

RESULTS 

Multiple CGM metrics were associated with progression to Stage 3 type 1 diabetes. Specifically, spending ≥5% time with glucose levels ≥140 mg/dL (p = 0.01), ≥8% time ≥140 mg/dL (p=0.02), ≥5% time ≥160 mg/dL (p = 0.0001) and ≥8% of the time spent at glucose levels ≥160 mg/dL (p=0.02) were all associated with progression to Stage 3 disease. Stage 2 participants and those who progressed to Stage 3 also exhibited higher mean day-glucose values, spent more time with glucose values over 120, 140 and 160 mg/dL, and had greater variability.

CONCLUSIONS 

CGM could aid in the identification of subjects, including those with a normal OGTT, who are likely to rapidly progress to Stage 3 type 1 diabetes. 

Funding

This work was supported by the NIH/NIDDK grant (DP3DK101083), JDRF (SRA-2019-763-A-N), and the McNair Medical Institute at The Robert and Janice McNair Foundation. The Type 1 Diabetes TrialNet Study Group is a clinical trials network funded through a cooperative agreement by the National Institutes of Health (NIH) through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, through UC4 DK106993, and JDRF Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR003142 (Stanford), and URL1TR001427 (University of Florida). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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