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Distinct Patterns of Daily Glucose Variability by Pubertal Status in Youth With Type 1 Diabetes.

Authors
  • Zhu, Jia1, 2
  • Volkening, Lisa K1
  • Laffel, Lori M3, 2
  • 1 Pediatric, Adolescent, and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, MA.
  • 2 Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
  • 3 Pediatric, Adolescent, and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, MA [email protected]
Type
Published Article
Journal
Diabetes care
Publication Date
Jan 01, 2020
Volume
43
Issue
1
Pages
22–28
Identifiers
DOI: 10.2337/dc19-0083
PMID: 31308020
Source
Medline
Language
English
License
Unknown

Abstract

To evaluate glycemia and metrics of glucose variability in youth with type 1 diabetes, and to assess patterns of 24-h glucose variability according to pubertal status. Metrics of glycemia, glucose variability, and glucose patterns were assessed by using 4 weeks of continuous glucose monitoring (CGM) data from 107 youth aged 8-17 years with type 1 diabetes for ≥1 year. Glucose values per hour were expressed as percentages relative to the mean glucose over 24 h for a 4-week period. Glucose data were compared on the basis of pubertal status-prepubertal (Tanner stage [T] 1), pubertal (T2-4), and postpubertal (T5)-and A1C categories (<7.5% [<58 mmol/mol], ≥7.5% [≥58 mmol/mol]). Youth (50% female, 95% white) had a mean ± SD age of 13.1 ± 2.6 years, diabetes duration of 6.3 ± 3.5 years, and A1C of 7.8 ± 0.8% (62 ± 9 mmol/mol); 88% were pump treated. Prepubertal youth had a higher mean glucose SD (86 ± 12 mg/dL [4.8 ± 0.7 mmol/L]; P = 0.01) and coefficient of variation (CV) (43 ± 5%; P = 0.06) than did pubertal (SD 79 ± 13 mg/dL [4.4 ± 0.7 mmol/L]; CV 41 ± 5%) and postpubertal (SD 77 ± 14 mg/dL [4.3 ± 0.8 mmol/L]; CV 40 ± 5%) youth. Over 24 h, prepubertal youth had the largest excursions from mean glucose and the highest CV across most hours compared with pubertal and postpubertal youth. Across all youth, CV was strongly correlated with the percentage of time with glucose <70 mg/dL (<3.9 mmol/L) (r = 0.79; P < 0.0001). Prepubertal youth had greater glucose variability independent of A1C than did pubertal and postpubertal youth. A1C alone does not capture the full range of glycemic parameters, highlighting the added insight of CGM in managing youth with type 1 diabetes. © 2019 by the American Diabetes Association.

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