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Glucose sensor evaluation of glycemic instability in pediatric type 1 diabetes mellitus
Ramin Alemzadeh1, Cindy Loppnow, Elaine Parton
1Department of Pediatrics, MACC Fund Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. ralemzad@mcw.edu
Insights
Glycemic instability in children with type 1 diabetes mellitus is linked to lipohypertrophy and insulin dosing. Continuous Glucose Monitoring System (CGMS) data helps identify factors affecting blood glucose (BG) fluctuations.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Diseases
Background:
- Maintaining target blood glucose (BG) levels is challenging for children with type 1 diabetes mellitus (DM).
- Glycemic instability and frequent hypoglycemia are common concerns in this population.
- Continuous Glucose Monitoring Systems (CGMS) offer detailed insights into BG patterns.
Purpose of the Study:
- To identify factors contributing to glycemic instability in pediatric patients with type 1 DM.
- To analyze CGMS profiles for correlations with clinical parameters.
- To characterize BG variability in children experiencing frequent fluctuations.
Main Methods:
- Analysis of 48-hour CGMS data from 30 pediatric patients with type 1 DM and a history of BG fluctuations.
- Calculation of Mean Blood Glucose (MBG), Absolute Means of Daily Differences (MODD), Mean Amplitude of Glycemic Excursion (MAGE), and number of hypoglycemic events.
- Statistical correlation analysis between CGMS metrics and factors like glycosylated hemoglobin (HbA1c) and lipohypertrophy.
Main Results:
- Significant correlation found between MBG and HbA1c.
- Severity of lipohypertrophy correlated significantly with both HbA1c and MODD values.
- MAGE values positively correlated with bolus:basal insulin ratio and number of hypoglycemic events.
Conclusions:
- CGMS 48-hour profiles effectively characterize BG variability in children with type 1 DM.
- Injection site lipohypertrophy and insulin dosing strategies are significant factors influencing glycemic instability.
- Identifying these factors can aid in optimizing diabetes management for improved BG control.
Abstract:
Maintaining blood glucose (BG) levels within the target range can be an elusive goal in children with type 1 diabetes mellitus (DM). To identify factor(s) that may contribute to glycemic instability, we analyzed the Continuous Glucose Monitoring System (CGMS) (Medtronic MiniMed, Northridge, CA) profiles of a group of children with type 1 DM and a history of frequent BG fluctuations and hypoglycemia. A total of 30 (17 girls, 13 boys) pediatric patients with a history of frequent BG fluctuations and hypoglycemia (mean age, 10.5 +/- 0.7 years; duration, 5.0 +/- 0.6 years), on three to four injections of insulin daily or insulin pump therapy, were evaluated by the CGMS. The mean BG (MBG), absolute means of daily differences (MODD), mean amplitude of glycemic excursion (MAGE), and number of hypoglycemic events (BG <60 mg/dL) for 48 h were calculated in each patient. There was a significant correlation between MBG and glycosylated hemoglobin (HbA1c) (r(2) = 0.22, p < 0.009). There was also a significant correlation between severity of lipohypertrophy and glycemic control (HbA1c) (r(2) = 0.20, p < 0.01). The MODD values had a positive correlation with the severity of injection site lipohypertrophy (r(2) = 0.37, p < 0.0003). The MAGE values had a positive correlation with bolus:basal insulin ratio (r(2) = 0.22, p < 0.009) and number of hypoglycemic events (r(2) = 0.21, p < 0.008), independent of age, MBG, and glycemic control. The 48-h CGMS profile can help characterize day-to-day and within-day BG variability and identify factors influencing glycemic instability in pediatric type 1 DM.