Continuous Glucose Monitoring Variables and HbA1c in Children and Adolescents with Type 1 Diabetes CGM variables and HbA1c in T1DM children
Main Article Content
Abstract
Objective: Associations between Continious Glucose Monitoring (CGM) variables (metrics) and HbA1c is not well understood. In this exploratory study we assessed the association between mean sensor glucose (mean CGM) and HbA1c and how it is affected by sensor type (real-time CGM vs. intermittent scanned CGM), patient characteristics, and other CGM variables in children and adolescents with type 1 diabetes.
Methods: Data were obtained from Swedish paediatric diabetes quality registry (SWEDIABKID) and Diasend. Paired HbA1c and CGM data collected within one year were analyzed, including a maximum of four individual HbA1c at least 2 months apart and for which CGM data were available for 12 weeks prior to HbA1c.
Results: 174 children were included of whom 141 had a diabetes duration ≥ 1-year; 71 used real-time CGM and 70 used intermittent scanned CGM. The intermittent scanned CGM children were older, had a higher proportion of children on insulin injections versus pump, and more CGM recordings during an 8-week registration. A stronger correlation between HbA1c and mean CGM was observed based on a sensor period ≥ 8 weeks preceding HbA1c in children with ≥ 1-year diabetes duration (r= 0.70, p<0.01). HbA1c was more weakly correlated with Time In Range (r=-0.40, p<0.01). Low HbA1c and low CGM Standard Deviation and, for intermittent scanned CGM, higher daily sensor duration was associated with a stronger correlation between mean CGM and HbA1c. HbA1c was dependent on Time Above Range and Time Below Range in intermittent scanned CGM users while in real-time CGM only Time Above Range impacted.
Conclusions: HbA1c correlated only moderately with mean CGM and discrepancies should be expected for the child with short diabetes duration, high HbA1c or high CGM Standard Deviation.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Tauschmann M, Forlenza G, Hood K, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Glucose monitoring. Pediatr Diabetes. 2022;23(8): 1390-1405.
3. Beck RW, Bergenstal RM, Riddlesworth TD, et al. Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care. 2019;42(3):400-405.
4. Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019; 42(8):1593-1603
5. American Diabetes Association. 7. Diabetes technology: standards of medical care in diabetes—2021. Dia Care. 2021;44 (Supplement 1):S85-S99.
6. Klonoff DC. Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care. 2005;28 (5):1231-9.
7. Nardacci EA, Bode BW, Hirsch IB. Individualizing care for the many: the evolving role of professional continuous glucose monitoring systems in clinical practice. Diabetes Educ. 2010;36 Suppl 1:4S-19S; quiz 20S-1S.
8. Iqbal A, Novodvorsky P, Heller SR. Recent Updates on Type 1 Diabetes Mellitus Management for Clinicians. Diabetes Metab J. 2018;42(1):3-18.
9. Danne T, Nimri R, Battelino T et al. International Consensus on Use of Continuous Glucose Monitoring. Diabetes Care. 2017;40 (12):1631-40.
10. Beck RW, Connor CG, Mullen DM, Wesley DM, Bergenstal RM. The Fallacy of Average: How Using HbA1c Alone to Assess Glycemic Control Can Be Misleading. Diabetes Care. 2017;40(8):994-9.
11. Ajjan RA. How Can We Realize the Clinical Benefits of Continuous Glucose Monitoring? Diabetes Technol Ther. 2017; 19(S2):S27-S36.
12. Swedish Pediatric Association. BLF:s Sub-association for Endocrinology and Diabetes. Guidelines on Continuous Glucose Monitoring (CGM) for children and adolescents with T1DM. Available from http://endodiab.barnlakarforeningen.se/vardprogram/diabetes/. Accessed 12 november 2023
13. Yeh HC, Brown TT, Maruthur N et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med. 2012;157(5):336-47.
14. Pickup JC, Freeman SC, Sutton AJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ. 2011;343:d3805.
15. Tyndall V, Stimson RH, Zammitt NN, et al. Marked improvement in HbA1c following commencement of flash glucose monitoring in people with type 1 diabetes. Diabetologia. 2019;62(8):1349-1356.
16. Choudhary P, Ramasamy S, Green L et al. Real-time continuous glucose monitoring significantly reduces severe hypoglycemia in hypoglycemia-unaware patients with type 1 diabetes. Diabetes Care. 2013;36(12):4160-2.
17. Ludvigsson J, Hanas R. Continuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: a controlled crossover study. Pediatrics. 2003;111(5 Pt 1):933-8.
18. Wong JC, Foster NC, Maahs DM et al. Real-time continuous glucose monitoring among participants in the T1D Exchange clinic registry. Diabetes Care. 2014;37(10):2702-9.
19. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications (DCCT) Research Group. Kidney Int. 1995;47(6):1703-20.
20. Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: The Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA. 2003;290(16):2159-67.
21. Nordwall M, Fredriksson M, Ludvigsson J, Arnqvist HJ. Impact of Age of Onset, Puberty, and Glycemic Control Followed From Diagnosis on Incidence of Retinopathy in Type 1 Diabetes: The VISS Study. Diabetes Care. 2019;42(4):609-616.
22. Sartore G, Chilelli NC, Burlina S et al. The importance of HbA1c and glucose variability in patients with type 1 and type 2 diabetes: outcome of continuous glucose monitoring (CGM). Acta Diabetol. 2012;49 Suppl 1:S153-60.
23. Freedman BI, Shihabi ZK, Andries L et al. Relationship between assays of glycemia in diabetic subjects with advanced chronic kidney disease. Am J Nephrol. 2010;31(5): 375-9.
24. Petrie JR, Peters AL, Bergenstal RM, Holl RW, Fleming GA, Heinemann L. Improving the clinical value and utility of CGM systems: issues and recommendations : A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetologia. 2017;60(12):2319-2328.
25. Nathan DM, Turgeon H, Regan S. Relationship between glycated haemoglobin levels and mean glucose levels over time. Diabetologia. 2007;50(11):2239-44.
26. Frank L Schwartz CRM. Glycemic Variability in Type 1 Diabetes—Does It Matter? US Endocrinology. 2014;10(1):20–4.
27. Beck RW, Bergenstal RM, Cheng P, et al. The relationships between time in range, hyperglycemia metrics, and HbA1c. J Diabetes Sci Technol. 13 January 2019
28. VigerskyRA,McMahonC.Therelationshipof hemoglobin A1C to time-in-range in patients with diabetes. Diabetes Technol Ther 2019;21: 81–85
29. Hoey H, Aanstoot HJ, Chiarelli F et al. Good metabolic control is associated with better quality of life in 2,101 adolescents with type 1 diabetes. Diabetes Care. 2001;24(11): 1923-8.