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Glycemic Variability Patterns Strongly Correlate with Partial Remission Status in Children With Newly Diagnosed Type 1 Diabetes

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posted on 2022-08-23, 19:27 authored by Olivier G. Pollé, Antoine Delfosse, Manon Martin, Louis Jacques, Inge Gies, Marieke den Brinker, Nicole Seret, Marie-Christine Lebrethon, Thierry Mouraux, Laurent Gatto, Philippe A. Lysy, DIATAG Working Group

  

Objective: To evaluate whether indexes of glycemic variability may overcome residual β-cell secretion estimates in the longitudinal evaluation of partial remission in a cohort of pediatric new-onset type 1 diabetes patients.

Research Design and Methods: Values of residual β-cell secretion estimates, clinical parameters (e.g. HbA1C or insulin daily dose) and continuous glucose monitoring (CGM) from 78 new-onset type 1 diabetes pediatric patients were longitudinally collected during one year and cross-sectionally compared. Circadian patterns of CGM metrics were characterized and correlated to remission status using adjusted mixed-effects model. Patients were clustered based on forty-six CGM metrics and clinical parameters, and compared using non-parametric ANOVA.

Results: Study participants had a mean (±SD) age of 10.4 (±3.6) years at diabetes onset and 65% underwent partial remission at +3 months. β-cell residual secretion estimates demonstrated weak-to-moderate correlations with clinical parameters and CGM metrics (r²= 0.05-0.25, p<0.05). However, CGM metrics strongly correlated with clinical parameters (r² >0.52, p<0.05) and were sufficient to distinguish remitters from nonremitters. Also, CGM metrics from remitters displayed specific early morning circadian patterns characterized by increased glycemic stability across days (within 63-140 mg/dL range) and decreased rate of grade II hypoglycemia (p<0.0001), compared to nonremitters. Thorough CGM analysis allowed the identification of four novel glucotypes (p<0.001) that segregate patients into subgroups and mirror the evolution of remission after diabetes onset. 

Conclusion: In our pediatric cohort, combination of CGM metrics and clinical parameters unraveled key clinical milestones of glucose homeostasis and remission status during the first year of type 1 diabetes.  

Funding

This research was supported by funding from the Fond National de la Recherche Scientifique (FRIA grant, FSR starting grant), Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED), Société Francophone du Diabète (SFD). The content is solely the responsibility of the authors and does not represent the official views of these organizations.

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