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Beyond HbA1c: Identifying Gaps in Glycemic Control Among Children and Young People with Type 1 Diabetes Using
Ambica Tandon1, Eshita Bhowmik1, Zebish Ali1
1Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
Indian Journal of Pediatrics
|April 19, 2024
Summary
Continuous glucose monitoring (CGM) in young people with Type 1 diabetes mellitus (T1DM) reveals significant glycemic variability and time spent in hyperglycemia or hypoglycemia. CGM data complements HbA1c for better diabetes management.
Area of Science:
- Endocrinology and Metabolism
- Pediatric Diabetes Management
Background:
- Type 1 diabetes mellitus (T1DM) management in young individuals requires precise glycemic control.
- Continuous glucose monitoring (CGM) offers detailed insights into glycemic fluctuations beyond traditional HbA1c measurements.
Purpose of the Study:
- To characterize glycemic variables derived from CGM in young people with T1DM.
- To investigate the associations between these CGM-derived variables, HbA1c levels, and socio-economic factors.
Main Methods:
- Ninety-two participants with T1DM (mean age 15.7 years, mean HbA1c 8.0%) underwent 14-day professional CGM.
- Analysis focused on time in range (TIR), time above range (TAR), time below range (TBR), and glycemic variability (percent CV).
Main Results:
- Median TIR was 41%, with participants experiencing significant hyperglycemia (41%) and hypoglycemia (14%).
- High glycemic variability (CV >36%) was prevalent in 92% of participants.
- Older age at diagnosis correlated with higher TIR and lower TAR, while insulin type (NPH vs. glargine) influenced TBR and TAR. HbA1c strongly correlated with TIR, TBR, TAR, and mean glucose.
Conclusions:
- Significant discrepancies exist between recommended and actual glycemic control in young T1DM patients on multiple daily insulin injections.
- CGM effectively identifies glycemic variability and provides complementary data to HbA1c, aiding in the optimization of glycemic control strategies.
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