Continuous Glucose Monitoring Metrics as a Predictor of Acute Complications in Youth with Type 1 Diabetes

Continuous glucose monitors (CGMs) offer insight into glycemic control but have not been established as predictors of acute diabetes complications. Using data from 120 youth with type 1 diabetes (ages 8-17) enrolled in a 24-month study, we investigated associations of CGM-derived metrics (time-in-range [TIR] 70-180 mg/dL, time <70, time >180, time >250, mean glucose, glucose coefficient of variation [CV]) with incidence rates of severe hypoglycemia and diabetic ketoacidosis (DKA)/severe hyperglycemia. Over 285 person-years of follow-up, there were 75 events of severe hypoglycemia and 15 events of DKA/severe hyperglycemia. TIR and CV were significantly associated with severe hypoglycemia. Those with <45% TIR had 2.09 times the rate of severe hypoglycemia than those with ≥45% TIR (P = 0.003). Those with CV ≥41% had 2.03 times the rate of severe hypoglycemia than those with CV <41% (P = 0.006). No CGM metrics were significantly associated with DKA/severe hyperglycemia. CGM data could serve as additional predictors for acute complications, particularly severe hypoglycemia.