Glycemic Variability Assessment in Newly Treated Exocrine Pancreatic Insufficiency With Type 1 Diabetes

Area of Science:

• Endocrinology
• Metabolism
• Diabetes Management

Background:

• Type 1 diabetes (T1D) is often associated with exocrine pancreatic insufficiency (EPI), affecting pancreatic elastase levels.
• Exocrine pancreatic insufficiency (EPI) necessitates oral pancreatic enzyme supplementation.
• The glycemic impact of pancreatic enzyme replacement therapy (PERT) in diabetic individuals remains under-researched.

Purpose of the Study:

• To assess the impact of PERT on glycemic variability (GV) and glycemic outcomes in an individual with T1D and EPI.
• To demonstrate a method for evaluating medication efficacy using automated insulin delivery (AID) data and GV metrics.

Main Methods:

• A single-subject (n=1) design was employed, collecting data for one month before and one month after PERT initiation.
• Diabetes data were gathered using an open-source AID system and uploaded via Nightscout to Open Humans.
• Self-tracked data included macronutrients, PERT dosage, and EPI symptoms; breakfast was analyzed separately.

Main Results:

• The individual's time in range (TIR) improved after commencing PERT, building upon an already above-goal baseline.
• Significant reductions were observed in glucose rate of change and excursions exceeding 180 mg/dL.
• The mean high blood glucose index decreased overall, with a more pronounced reduction noted specifically at breakfast.

Conclusions:

• Glycemic variability analysis proved effective in assessing the response to PERT in a T1D individual with EPI.
• GV metrics offer a valuable tool for evaluating the efficacy of new medications in patients with insulin-requiring diabetes.