CGM Metrics Identify Dysglycemic States in Participants From the TrialNet Pathway to Prevention Study

Author:

Wilson Darrell M.1ORCID,Pietropaolo Susan L.2,Acevedo-Calado Maria2,Huang Shuai3,Anyaiwe Destiny4,Scheinker David1ORCID,Steck Andrea K.5ORCID,Vasudevan Madhuri M.2,McKay Siripoom V.26,Sherr Jennifer L.7ORCID,Herold Kevan C.8ORCID,Dunne Jessica L.9ORCID,Greenbaum Carla J.10ORCID,Lord Sandra M.10,Haller Michael J.11ORCID,Schatz Desmond A.11ORCID,Atkinson Mark A.11ORCID,Nelson Patrick W.4,Pietropaolo Massimo2ORCID,

Affiliation:

1. 1Division of Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, CA

2. 2Division of Endocrinology, Diabetes, and Metabolism, Diabetes Research Center, Department of Medicine, Baylor College of Medicine, Houston, TX

3. 3Department of Industrial & Systems Engineering, University of Washington, Seattle, WA

4. 4Department of Mathematics & Computer Science, Lawrence Technological University, Southfield, MI

5. 5Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO

6. 6Department of Pediatrics, Baylor College of Medicine, Houston, TX

7. 7Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT

8. 8Departments of Immunobiology and Internal Medicine, Yale University, New Haven, CT

9. 9JDRF, New York, NY

10. 10Center for Interventional Immunology and Diabetes Program, Benaroya Research Institute, Seattle, WA

11. 11Department of Pediatrics, University of Florida Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL

Abstract

OBJECTIVEContinuous glucose monitoring (CGM) parameters may identify individuals at risk for progression to overt type 1 diabetes. We aimed to determine whether CGM metrics provide additional insights into progression to clinical stage 3 type 1 diabetes.RESEARCH DESIGN AND METHODSOne hundred five relatives of individuals in type 1 diabetes probands (median age 16.8 years; 89% non-Hispanic White; 43.8% female) from the TrialNet Pathway to Prevention study underwent 7-day CGM assessments and oral glucose tolerance tests (OGTTs) at 6-month intervals. The baseline data are reported here. Three groups were evaluated: individuals with 1) stage 2 type 1 diabetes (n = 42) with two or more diabetes-related autoantibodies and abnormal OGTT; 2) stage 1 type 1 diabetes (n = 53) with two or more diabetes-related autoantibodies and normal OGTT; and 3) negative test for all diabetes-related autoantibodies and normal OGTT (n = 10).RESULTSMultiple CGM metrics were associated with progression to stage 3 type 1 diabetes. Specifically, spending ≥5% time with glucose levels ≥140 mg/dL (P = 0.01), ≥8% time with glucose levels ≥140 mg/dL (P = 0.02), ≥5% time with glucose levels ≥160 mg/dL (P = 0.0001), and ≥8% time with glucose levels ≥160 mg/dL (P = 0.02) were all associated with progression to stage 3 disease. Stage 2 participants and those who progressed to stage 3 also exhibited higher mean daytime glucose values; spent more time with glucose values over 120, 140, and 160 mg/dL; and had greater variability.CONCLUSIONSCGM could aid in the identification of individuals, including those with a normal OGTT, who are likely to rapidly progress to stage 3 type 1 diabetes.

Funder

National Institute of Diabetes and Digestive and Kidney Diseases

JDRF

Robert and Janice McNair Foundation

National Center for Advancing Translational Sciences

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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