American Diabetes Association
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Residual β-cell function is associated with longer time in range in individuals with type 1 diabetes

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posted on 2023-08-03, 19:41 authored by Coco M. Fuhri Snethlage, Timothy J. McDonald, Richard D. Oram, Pleun de Groen, Elena Rampanelli, Alinda W.M. Schimmel, Frits Holleman, Sarah Siegelaar, Joost Hoekstra, Catherine B. Brouwer, Filip K. Knop, C. Bruce Verchere, Daniël H. van Raalte, Bart O. Roep, Max Nieuwdorp, Nordin M.J. Hanssen


Objective. Little is known about the influence of residual islet function on glycemic control in type 1 diabetes (T1D). Therefore, we investigated the associations between residual β-cell function and metrics of continuous glucose monitoring (CGM) in individuals with T1D.

Research design and methods. In this cross-sectional cohort, comprised of 489 individuals, 64% was female, age was 41.0±14.0 years, T1D duration was 15.0 [IQR 6.0-29.0] years. Individuals had a time in range (TIR) of 66% [IQR 52-80] and UCPCR of 0.01 [IQR 0.00-0.41] nmol/mmol. To assess β-cell function, we measured urinary C-peptide/creatinine ratios (UCPCR, detectable >0.01nmol/mmol) and to assess α-cell function fasting plasma glucagon/glucose ratios were measured. CGM was used to record TIR (3.9-10 mmol/L), time below range (TBR) (<3.9 mmol/L), time above range (TAR) (>10 mmol/L) and coefficient of variance (CV). For CGM, 74.7% used Freestyle Libre-2, 13.8% Metronic-Guardian and 11.5% DexcomG6 as device.

Results. 49.4% of T1D had detectable UCPCR. A higher UCPCR correlated with higher TIR (r=0.330, p <0.05), lower TBR (r=-0.237, p <0.05), lower TAR (r=-0.302, p <0.05), and lower CV (r=-0.356, p <0.05), respectively. A higher UCPCR correlated negatively with HbA1c levels (r =-0.183, p <0.05) and total daily insulin dose (r=-0.183, p <0.05). Glucagon/glucose ratios correlated with longer TIR (r=0.234, p <0.05).

Conclusions. Significantly longer TIR, shorter TBR and TAR and lower CV were observed in individuals with greater UCPCR-assessed β-cell function. Therefore, better CGM-derived metrics in individuals with preserved β-cell function may be a contributor to a lower risk of developing long-term complications.


Funding and Assistance. This research was supported by a DNF DON grant 2020, number 2020.10.002 on which C.F.S. and N.M.H. are appointed. N.M.H. is supported by a Senior Clinical Dekker grant by the Dutch Heart Foundation (grant number 2021T055). M.N. is supported by a personal ZONMW-VICI grant 2020 (09150182010020).