Achievement of Target A1C Levels With Negligible Hypoglycemia and Low Glucose Variability in Youth With Short-Term Type 1 Diabetes and Residual β-Cell Function

  1. on behalf of the Diabetes Research in Children Network (DirecNet) Study Group*
  1. 1Pediatric Endocrinology, Yale University, New Haven, Connecticut; the 2Jaeb Center for Health Research, Tampa, Florida
  2. 2Jaeb Center for Health Research, Tampa, Florida
  3. 3Pediatric Endocrinology, University of Iowa, Iowa City, Iowa
  4. 4Pediatric Endocrinology, Nemours Children’s Clinic, Jacksonville, Florida
  5. 5Pediatric Endocrinology, Stanford University, Stanford, California
  6. 6Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
  1. Corresponding author: Jennifer Sherr, direcnet{at}jaeb.org.

Abstract

OBJECTIVE To determine exposure to hyper- and hypoglycemia using blinded continuous glucose monitoring (CGM) profiles in youth with type 1 diabetes (T1D) with residual β-cell function during the first year of insulin treatment.

RESEARCH DESIGN AND METHODS Blinded, 3–7 day CGM profiles were obtained in 16 short-term T1D patients (age 8–18 years, T1D duration 6–52 weeks) who had peak C-peptide levels ranging from 0.46 to 1.96 nmol/L during a mixed-meal tolerance test. Results in this short-term group were compared with those in 34 patients with well-controlled, longer-term T1D (duration ≥5 years), matched for age and A1C with the short-term T1D group, and with those in 26 age-matched nondiabetic individuals.

RESULTS Despite matching for A1C, and therefore similar mean sensor glucose levels in the two T1D groups, short-term T1D participants had a lower frequency of hypoglycemia (0.3 vs. 7.6%, P < 0.001), a trend toward less hyperglycemia (17 vs. 32%, P = 0.15), and a greater percentage in the target range (median 77 vs. 60%, P = 0.02). Indeed, the percentage of sensor glucose levels ≤70 mg/dL in the short-term T1D group (0.3%) did not differ from those in the nondiabetic group (1.7%, P = 0.73). The coefficient of variation of sensor glucose levels (an index of glucose variability) was lower in short-term vs. longer-term T1D participants (27 vs. 42%, respectively, P < 0.001).

CONCLUSIONS In youth with short-term T1D who retain residual β-cell function, there is negligible exposure to hypoglycemia and lower glucose variability than in youth with well-controlled T1D of longer duration.

  • Received November 11, 2011.
  • Accepted December 13, 2011.

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