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
- Jennifer Sherr, MD1⇓,
- William V. Tamborlane, MD1,
- Dongyuan Xing, MPH2,
- Eva Tsalikian, MD3,
- Nelly Mauras, MD4,
- Bruce Buckingham, MD5,
- Neil H. White, MD6,
- Ana Maria Arbelaez, MD6,
- Roy W. Beck, MD, PHD2,
- Craig Kollman, PHD2,
- Katrina Ruedy, MSPH2 and
- on behalf of the Diabetes Research in Children Network (DirecNet) Study Group*
- 1Pediatric Endocrinology, Yale University, New Haven, Connecticut; the 2Jaeb Center for Health Research, Tampa, Florida
- 2Jaeb Center for Health Research, Tampa, Florida
- 3Pediatric Endocrinology, University of Iowa, Iowa City, Iowa
- 4Pediatric Endocrinology, Nemours Children’s Clinic, Jacksonville, Florida
- 5Pediatric Endocrinology, Stanford University, Stanford, California
- 6Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
- Corresponding author: Jennifer Sherr, .
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.
- © 2012 by the American Diabetes Association.
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