Glycemic Variability Patterns Strongly Correlate With Partial Remission Status in Children With Newly Diagnosed Type
Olivier G Pollé1,2, Antoine Delfosse1,2, Manon Martin3
1Pôle de PEDI, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium.
Insights
Continuous glucose monitoring (CGM) metrics effectively track type 1 diabetes remission in children, outperforming traditional β-cell secretion estimates. These CGM insights reveal distinct glycemic patterns and aid in classifying patient subgroups for better management.
Area of Science:
- Endocrinology and Metabolism
- Pediatric Diabetes Research
- Biomedical Data Science
Background:
- Evaluating partial remission in new-onset type 1 diabetes (T1D) in pediatric patients is crucial for long-term management.
- Traditional markers like residual β-cell secretion estimates may not fully capture the nuances of glycemic control during remission.
- Continuous glucose monitoring (CGM) offers detailed insights into glucose variability and patterns.
Purpose of the Study:
- To determine if glycemic variability indexes from CGM can better assess partial remission in pediatric T1D compared to residual β-cell secretion estimates.
- To longitudinally evaluate remission status in a cohort of children with new-onset T1D using CGM data.
Main Methods:
- Longitudinal data (1 year) on residual β-cell secretion, clinical parameters (HbA1c, insulin dose), and CGM metrics were collected from 78 pediatric T1D patients.
- Circadian CGM patterns were analyzed and correlated with remission status using mixed-effects models.
- Patients were clustered based on CGM metrics and clinical parameters using nonparametric ANOVA.
Main Results:
- CGM metrics strongly correlated with clinical parameters (r² > 0.52) and effectively distinguished between patients in remission and those not.
- Remitters exhibited distinct early morning circadian glucose patterns with improved stability (63-140 mg/dL) and reduced hypoglycemia.
- Four novel glucotypes were identified through CGM analysis, segregating patients and reflecting remission evolution.
Conclusions:
- CGM metrics, combined with clinical parameters, provide a comprehensive understanding of glucose homeostasis and remission status in pediatric T1D during the first year post-diagnosis.
- Glycemic variability indexes derived from CGM are superior to residual β-cell secretion estimates for longitudinal evaluation of partial remission in pediatric T1D.
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 patients with new-onset type 1 diabetes.
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 pediatric patients with new-onset type 1 diabetes were longitudinally collected during 1 year and cross-sectionally compared. Circadian patterns of CGM metrics were characterized and correlated to remission status using an adjusted mixed-effects model. Patients were clustered based on 46 CGM metrics and clinical parameters and compared using nonparametric 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 with 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.
Conclusions:
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.
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