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Rizzi A, Tartaglione L, Lucaccini Paoli L, Leo ML, Popolla V, Viti L, Barberio A, Di Leo M, Pontecorvi A, Pitocco D. Evaluation of time in tight range and the glycaemia risk index in adults with type 1 diabetes using an advanced hybrid closed loop system: A 1-year real-world assessment. Diabetes Obes Metab 2024; 26:4078-4086. [PMID: 39010292 DOI: 10.1111/dom.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/13/2024] [Accepted: 06/22/2024] [Indexed: 07/17/2024]
Abstract
AIM To assess the long-term glycaemic outcomes, with additional metrics, in adults with type 1 diabetes (T1D) using the Tandem t:slim X2 with Control-IQ technology advanced hybrid closed-loop (AHCL) system. METHODS This was a single-centre, retrospective study involving 56 T1D patients who transitioned to the Tandem t:slim X2 with Control-IQ system. The primary and secondary endpoints consisted of variations in time in tight range (TiTR; 70-140 mg/dL) and the glycaemia risk index (GRI), respectively. Additional standardized continuous glucose monitoring (CGM) metrics, mean sensor glucose, coefficient of variation, the glucose management indicator (GMI), HbA1c and insulin daily dose, were also evaluated. Variables were measured at baseline and at 15 days, 3 months, 6 months and 1 year after Tandem t:slim X2 Control-IQ initiation. Glucose outcomes are expressed as mean (standard deviation). RESULTS Use of Tandem t:slim X2 with Control-IQ over 1 year was associated with an increase in mean TiTR, from 38.11% (17.05%) to 43.10% (13.20%) (P = .059), and with a decline in the GRI, from 41.03 (25.48) to 28.55 (16.27) (P = .008). CGM metrics, including time in range and time above range, showed consistent improvements. Mean sensor glucose, the GMI and HbA1c decreased significantly over time. After an initial increase, insulin daily dose remained stable throughout the 12 months. CONCLUSIONS The results highlight the sustained effectiveness of Tandem t:slim X2 with Control-IQ in improving glycaemic outcomes over 1 year and support the use of this technology for the management of T1D.
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Affiliation(s)
- Alessandro Rizzi
- Diabetes Care Unit, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Linda Tartaglione
- Diabetes Care Unit, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Lucaccini Paoli
- Diabetes Care Unit, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Laura Leo
- Diabetes Care Unit, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Popolla
- Diabetes Care Unit, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Viti
- Diabetes Care Unit, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Annarita Barberio
- Diabetes Care Unit, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Di Leo
- Diabetes Care Unit, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Pontecorvi
- Department of Endocrinology, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Fondazione Policlinico Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy
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Tanenbaum ML, Pang E, Tam R, Bishop FK, Prahalad P, Zaharieva DP, Addala A, Wong JJ, Naranjo D, Hood KK, Maahs DM. 'We're taught green is good': Perspectives on time in range and time in tight range from youth with type 1 diabetes, and parents of youth with type 1 diabetes. Diabet Med 2024:e15423. [PMID: 39118381 DOI: 10.1111/dme.15423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
AIMS Continuous glucose monitoring (CGM) systems are standard of care for youth with type 1 diabetes with the goal of spending >70% time in range (TIR; 70-180 mg/dL, 3.9-10 mmol/L). We aimed to understand paediatric CGM user experiences with TIR metrics considering recent discussion of shifting to time in tight range (TITR; >50% time between 70 and 140 mg/dL, 3.9 and 7.8 mmol/L). METHODS Semi-structured interviews and focus groups with adolescents with type 1 diabetes and parents of youth with type 1 diabetes focused on experiences with TIR goals and reactions to TITR. Groups and interviews were audio-recorded, transcribed and analysed using content analysis. RESULTS Thirty participants (N = 19 parents: age 43.6 ± 5.3 years, 79% female, 47% non-Hispanic White, 20 ± 5 months since child's diagnosis; N = 11 adolescents: age 15.3 ± 2 years, 55% female, 55% non-Hispanic White, 16 ± 3 months since diagnosis) attended. Participants had varying levels of understanding of TIR. Some developed personally preferred glucose ranges. Parents often aimed to surpass 70% TIR. Many described feelings of stress and disappointment when they did not meet a TIR goal. Concerns about TITR included increased stress and burden; risk of hypoglycaemia; and family conflict. Some participants said TITR would not change their daily lives; others said it would improve their diabetes management. Families requested care team support and a clear scientific rationale for TITR. CONCLUSIONS The wealth of CGM data creates frequent opportunities for assessing diabetes management and carries implications for management burden. Input from people with type 1 diabetes and their families will be critical in considering a shift in glycaemic goals and targets.
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Affiliation(s)
- Molly L Tanenbaum
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Erica Pang
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Rachel Tam
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Franziska K Bishop
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Priya Prahalad
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Dessi P Zaharieva
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Ananta Addala
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Jessie J Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - David M Maahs
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
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Piona C, Passanisi S, Bombaci B, Marigliano M, Lombardo F, Mancioppi V, Morandi A, Maffeis C, Salzano G. Time in tight range in automated insulin delivery system users: Real-world data from children and adolescents with type 1 diabetes. Diabetes Obes Metab 2024. [PMID: 39021339 DOI: 10.1111/dom.15791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Valentina Mancioppi
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
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Schiaffini R, Lumaca A, Martino M, Rapini N, Deodati A, Amodeo ME, Ciampalini P, Matteoli MC, Pampanini V, Cianfarani S. Time In Tight Range in children and adolescents with type 1 diabetes: A cross-sectional observational single centre study evaluating efficacy of new advanced technologies. Diabetes Metab Res Rev 2024; 40:e3826. [PMID: 38824455 DOI: 10.1002/dmrr.3826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/16/2024] [Accepted: 04/22/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Early and tight glycaemic control is crucial to prevent long-term complications of Type 1 Diabetes (T1D). The aim of our study was to compare glucose metrics, including Time In Tight Range (TITR), in a real-world setting. METHODS We performed a single-centre cross-sectional study in 534 children and adolescents with T1D. Participants were divided into four groups (multiple daily injections + real-time Continuous glucose monitoring (CGM), multiple daily injections + intermittently scanned CGM, sensor augmented pump (SAP), and Advanced Hybrid Closed-Loop (AHCL). Demographical and clinical data were collected and analysed. RESULTS The group with AHCL showed significantly higher Time In Range (TIR) (71.31% ± 10.88) than SAP (57.82% ± 14.98; p < 0.001), MDI + rtCGM (54.56% ± 17.04; p < 0.001) and MDI + isCGM (52.17% ± 19.36; p < 0.001) groups with a lower Time Above Range (p < 0.001). The group with AHCL also showed lower Time Below Range than MDI + isCGM and SAP groups (p < 0.01). The overall TITR was 37% ± 14 with 19% of participants who reached a TITR ≥50% with a mean TIR of 81%. AHCL had significantly higher TITR (45.46% ± 11.77) than SAP (36.25% ± 13.53; p < 0.001), MDI + rtCGM (34.03% ± 13.89; p < 0.001) and MDI + isCGM (33.37% ± 15.84; p < 0.001) groups with a lower Coefficient of Variation (p < 0.001). CONCLUSIONS Our study indicates that AHCL ensures a better glycaemic control with an improvement in both TIR and TITR, along with a reduction in CV. Implementation of automated insulin delivery systems should be considered in the treatment of children and adolescents with T1D.
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Affiliation(s)
- Riccardo Schiaffini
- Endocrine and Diabetes Unit - Bambino Gesù Childrens' Hospital - IRCCS-Piazza S Onofrio, Rome, Italy
| | - Alessandra Lumaca
- Pediatric Unit - Azienda Ospedaliero-Universitaria S. Anna - Via Aldo Moro, Ferrara, Italy
| | - Mariangela Martino
- Endocrine and Diabetes Unit - Bambino Gesù Childrens' Hospital - IRCCS-Piazza S Onofrio, Rome, Italy
- University of Rome 'Tor Vergata', Rome, Italy
| | - Novella Rapini
- Endocrine and Diabetes Unit - Bambino Gesù Childrens' Hospital - IRCCS-Piazza S Onofrio, Rome, Italy
| | - Annalisa Deodati
- Endocrine and Diabetes Unit - Bambino Gesù Childrens' Hospital - IRCCS-Piazza S Onofrio, Rome, Italy
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Maria Elisa Amodeo
- Endocrine and Diabetes Unit - Bambino Gesù Childrens' Hospital - IRCCS-Piazza S Onofrio, Rome, Italy
| | - Paolo Ciampalini
- Endocrine and Diabetes Unit - Bambino Gesù Childrens' Hospital - IRCCS-Piazza S Onofrio, Rome, Italy
| | - Maria Cristina Matteoli
- Endocrine and Diabetes Unit - Bambino Gesù Childrens' Hospital - IRCCS-Piazza S Onofrio, Rome, Italy
| | - Valentina Pampanini
- Endocrine and Diabetes Unit - Bambino Gesù Childrens' Hospital - IRCCS-Piazza S Onofrio, Rome, Italy
| | - Stefano Cianfarani
- Endocrine and Diabetes Unit - Bambino Gesù Childrens' Hospital - IRCCS-Piazza S Onofrio, Rome, Italy
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Passanisi S, Salzano G, Bombaci B, Minuto N, Bassi M, Bonfanti R, Scialabba F, Mozzillo E, Di Candia F, Monti S, Graziani V, Maffeis C, Piona CA, Arnaldi C, Tosini D, Felappi B, Roppolo R, Zanfardino A, Delvecchio M, Lo Presti D, Calzi E, Ripoli C, Franceschi R, Reinstadler P, Rabbone I, Maltoni G, Alibrandi A, Zucchini S, Marigliano M, Lombardo F. Sustained Effectiveness of an Advanced Hybrid Closed-Loop System in a Cohort of Children and Adolescents With Type 1 Diabetes: A 1-Year Real-World Study. Diabetes Care 2024; 47:1084-1091. [PMID: 38626260 DOI: 10.2337/dc23-2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/28/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE To investigate glucose metrics and identify potential predictors of the achievement of glycemic outcomes in children and adolescents during their first 12 months of MiniMed 780G use. RESEARCH DESIGN AND METHODS This multicenter, longitudinal, real-world study recruited 368 children and adolescents with type 1 diabetes (T1D) starting SmartGuard technology between June 2020 and June 2022. Ambulatory glucose profile data were collected during a 15-day run-in period (baseline), 2 weeks after automatic mode activation, and every 3 months. The influence of covariates on glycemic outcomes after 1 year of MiniMed 780G use was assessed. RESULTS After 15 days of automatic mode use, all glucose metrics improved compared with baseline (P < 0.001), except for time below range (P = 0.113) and coefficient of variation (P = 0.330). After 1 year, time in range (TIR) remained significantly higher than at baseline (75.3% vs. 62.8%, P < 0.001). The mean glycated hemoglobin (HbA1c) over the study duration was lower than the previous year (6.9 ± 0.6% vs. 7.4 ± 0.9%, P < 0.001). Time spent in tight range (70-140 mg/dL) was 51.1%, and the glycemia risk index was 27.6. Higher TIR levels were associated with a reduced number of automatic correction boluses (P < 0.001), fewer SmartGuard exits (P = 0.021), and longer time in automatic mode (P = 0.030). Individuals with baseline HbA1c >8% showed more relevant improvement in TIR levels (from 54.3% to 72.3%). CONCLUSIONS Our study highlights the sustained effectiveness of MiniMed 780G among youth with T1D. Findings suggest that even children and adolescents with low therapeutic engagement may benefit from SmartGuard technology.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Nicola Minuto
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Bassi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Riccardo Bonfanti
- Pediatric Diabetology Unit, Department of Pediatrics, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Francesco Scialabba
- Pediatric Diabetology Unit, Department of Pediatrics, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Enza Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Francesca Di Candia
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Sara Monti
- Pediatrics Unit, Department of Woman's and Child and Adolescent Health, Azienda Unità Sanitaria Locale (AUSL) Romagna, Bufalini Hospital, Cesena, Italy
| | - Vanna Graziani
- Pediatrics Unit, Department of Woman's and Child and Adolescent Health, AUSL Romagna, S. Maria delle Croci Hospital, Ravenna Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Claudia Anita Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Claudia Arnaldi
- Unitá Operativa Semplice Diabetologia Pediatrica ASL Viterbo, Viterbo, Italy
| | - Davide Tosini
- Unitá Operativa Semplice Diabetologia Pediatrica ASL Viterbo, Viterbo, Italy
| | - Barbara Felappi
- U.S. Auxoendocrinologia Pediatrica, Unitá Operativa Complessa Pediatria-Clinica Pediatrica, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Rosalia Roppolo
- Unitá Operativa Semplice Dipartimentale Diabetologia Pediatrica, Dipartimento di Pediatria, Ospedale dei Bambini, Palermo, Italia
| | - Angela Zanfardino
- Department of Pediatrics, Regional Center of Pediatric Diabetology "G.Stoppoloni," University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Donatella Lo Presti
- Regional Referral Centre of Pediatric Diabetes, University Hospital "Policlinico," Catania, Italy
| | - Elena Calzi
- Department of Pedatrics and Neonatology, ASST Crema Hospital, Crema, Italy
| | - Carlo Ripoli
- Pediatric Diabetology Unit, Department of Pediatrics, ASL 8 Cagliari, Cagliari, Italy
| | - Roberto Franceschi
- Department of Pediatrics, S. Chiara Hospital of Trento, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Petra Reinstadler
- Ospedale di Bolzano - Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | | | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
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Pulkkinen MA, Varimo TJ, Hakonen ET, Hero MT, Miettinen PJ, Tuomaala AK. During an 18-month course of automated insulin delivery treatment, children aged 2 to 6 years achieve and maintain a higher time in tight range. Diabetes Obes Metab 2024; 26:2431-2438. [PMID: 38514384 DOI: 10.1111/dom.15562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
AIMS To investigate whether the positive effects on glycaemic outcomes of 3-month automated insulin delivery (AID) achieved in 2- to 6-year-old children endure over an extended duration and how AID treatment affects time in tight range (TITR), defined as 3.9-7.8 mmol/L. RESEARCH DESIGN AND METHODS We analysed 18 months of follow-up data from a non-randomized, prospective, single-arm clinical trial (n = 35) conducted between 2021 and 2023. The main outcome measures were changes in time in range (TIR), glycated haemoglobin (HbA1c), time above range (TAR), TITR, and mean sensor glucose (SG) value during follow-up visits (at 0, 6, 12 and 18 months). The MiniMed 780G AID system in SmartGuard Mode was used for 18 months. Parental diabetes distress was evaluated at 3 and 18 months with the validated Problem Areas in Diabetes-Parent, revised (PAID-PR) survey. RESULTS Between 0 and 6 months, TIR and TITR increased, and HbA1c, mean SG value and TAR decreased significantly (p < 0.001); the favourable effect persisted through 18 months of follow-up. Between 3 and 18 months, PAID-PR score declined significantly (0 months: mean score 37.5; 3 months: mean score 28.6 [p = 0.06]; 18 months: mean score 24.6 [p < 0.001]). CONCLUSIONS Treatment with AID significantly increased TITR and TIR in young children. The positive effect of AID on glycaemic control observed after 6 months persisted throughout the 18 months of follow-up. Similarly, parental diabetes distress remained reduced during 18 months follow-up. These findings are reassuring and suggest that AID treatment improves glycaemic control and reduces parental diabetes distress in young children over an extended 18-month follow-up.
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Affiliation(s)
- Mari-Anne Pulkkinen
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero J Varimo
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Elina T Hakonen
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti T Hero
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi J Miettinen
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna-Kaisa Tuomaala
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Bahillo-Curieses P, Fernández Velasco P, Pérez-López P, Vidueira Martínez AM, Nieto de la Marca MDLO, Díaz-Soto G. Utility of time in tight range (TITR) in evaluating metabolic control in pediatric and adult patients with type 1 diabetes in treatment with advanced hybrid closed-loop systems. Endocrine 2024:10.1007/s12020-024-03881-6. [PMID: 38814372 DOI: 10.1007/s12020-024-03881-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To analyze the time in tight range (TITR), and its relationship with other glucometric parameters in patients with type 1 diabetes (T1D) treated with advanced hybrid closed-loop (AHCL) systems. METHODS A prospective observational study was conducted on pediatric and adult patients with T1D undergoing treatment with AHCL systems for at least 3 months. Clinical variables and glucometric parameters before and after AHCL initiation were collected. RESULTS A total of 117 patients were evaluated. Comparison of metabolic control after AHCL initiation showed significant improvements in HbA1c (6.9 ± 0.9 vs. 6.6 ± 0.5%, p < 0.001), time in range (TIR) (68.2 ± 11.5 vs. 82.5 ± 6.9%, p < 0.001), TITR (43.7 ± 10.8 vs. 57.3 ± 9.7%, p < 0.001), glucose management indicator (GMI) (6.9 ± 0.4 vs. 6.6 ± 0.3%, p < 0.001), time below range (TBR) 70-54 mg/dl (4.3 ± 4.5 vs. 2.0 ± 1.4%, p < 0.001), and time above range (TAR) > 180 mg/dl (36.0 ± 7.6 vs. 15.1 ± 6.4%, p < 0.001). Coefficient of variation (CV) also improved (36.3 ± 5.7 vs. 30.6 ± 3.7, p < 0.001), while time between 140-180 mg/dl remained unchanged. In total, 76.3% achieved TITR > 50% (100% pediatric). Correlation analysis between TITR and TIR and GRI showed a strong positive correlation, modified by glycemic variability. CONCLUSIONS AHCL systems achieve significant improvements in metabolic control (TIR > 70% in 93.9% patients). The increase in TIR was not related to an increase in TIR 140-180 mg/dl. Despite being closely related to TIR, TITR allows for a more adequate discrimination of the achieved control level, especially in a population with good initial metabolic control. The correlation between TIR and TITR is directly influenced by the degree of glycemic variability.
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Affiliation(s)
- Pilar Bahillo-Curieses
- Department of Pediatrics, Pediatric Endocrinology, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain.
| | - Pablo Fernández Velasco
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
| | - Paloma Pérez-López
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
| | - Ana María Vidueira Martínez
- Department of Pediatrics, Pediatric Endocrinology, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
| | - María de la O Nieto de la Marca
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
| | - Gonzalo Díaz-Soto
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
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8
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De Meulemeester J, Charleer S, Visser MM, De Block C, Mathieu C, Gillard P. The association of chronic complications with time in tight range and time in range in people with type 1 diabetes: a retrospective cross-sectional real-world study. Diabetologia 2024:10.1007/s00125-024-06171-y. [PMID: 38787436 DOI: 10.1007/s00125-024-06171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024]
Abstract
AIMS/HYPOTHESIS The aim of this study was to evaluate the association of chronic complications with time in tight range (TITR: 3.9-7.8 mmol/l) and time in range (TIR: 3.9-10.0 mmol/l) in people with type 1 diabetes. METHODS The prevalence of microvascular complications (diabetic retinopathy, diabetic nephropathy and diabetic peripheral neuropathy [DPN]) and macrovascular complications according to sensor-measured TITR/TIR was analysed cross-sectionally in 808 adults with type 1 diabetes. Binary logistic regression was used to evaluate the association between TITR/TIR and the presence of complications without adjustment, with adjustment for HbA1c, and with adjustment for HbA1c and other confounding factors (sex, age, diabetes duration, BMI, BP, lipid profile, smoking, and use of statins and renin-angiotensin-aldosterone system inhibitors). RESULTS The mean TITR and TIR were 33.9 ± 12.8% and 52.5 ± 15.0%, respectively. Overall, 46.0% had any microvascular complication (34.5% diabetic retinopathy, 23.8% diabetic nephropathy, 16.0% DPN) and 16.3% suffered from any macrovascular complication. The prevalence of any microvascular complication, diabetic retinopathy, diabetic nephropathy and a cerebrovascular accident (CVA) decreased with increasing TITR/TIR quartiles (all ptrend<0.05). Each 10% increase in TITR was associated with a lower incidence of any microvascular complication (OR 0.762; 95% CI 0.679, 0.855; p<0.001), diabetic retinopathy (OR 0.757; 95% CI 0.670, 0.856; p<0.001), background diabetic retinopathy (OR 0.760; 95% CI 0.655, 0.882; p<0.001), severe diabetic retinopathy (OR 0.854; 95% CI 0.731, 0.998; p=0.048), diabetic nephropathy (OR 0.799; 95% CI 0.699, 0.915; p<0.001), DPN (OR 0.837; 95% CI 0.717, 0.977; p=0.026) and CVA (OR 0.651; 95% CI 0.470, 0.902; p=0.010). The independent association of TITR with any microvascular complication (OR 0.867; 95% CI 0.762, 0.988; p=0.032), diabetic retinopathy (OR 0.837; 95% CI 0.731, 0.959; p=0.010), background diabetic retinopathy (OR 0.831; 95% CI 0.705, 0.979; p=0.027) and CVA (OR 0.619; 95% CI 0.426, 0.899; p=0.012) persisted after adjustment for HbA1c. Similar results were obtained when controlling for HbA1c and other confounding factors. CONCLUSIONS/INTERPRETATION TITR and TIR are inversely associated with the presence of microvascular complications and CVA in people with type 1 diabetes. Although this study was not designed to establish a causal relationship, this analysis adds validity to the use of TITR and TIR as key measures in glycaemic management. TRIAL REGISTRATION ClinicalTrials.gov NCT02601729 and NCT02898714.
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Affiliation(s)
| | - Sara Charleer
- Department of Endocrinology, University Hospitals Leuven - KU Leuven, Leuven, Belgium
| | - Margaretha M Visser
- Department of Endocrinology, University Hospitals Leuven - KU Leuven, Leuven, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology & Metabolism, University Hospital Antwerp - University of Antwerp, Edegem, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven - KU Leuven, Leuven, Belgium
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven - KU Leuven, Leuven, Belgium.
- Fonds Wetenschappelijk Onderzoek, Brussels, Belgium.
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Yuan L, Luo Y, Luo Y, Ding B, Zhang P, Ma J, Wu J. Ultra rapid lispro improves postprandial glucose control versus lispro in combination with basal insulin: a study based on CGM in type 2 diabetes in China. Front Endocrinol (Lausanne) 2024; 15:1364585. [PMID: 38774225 PMCID: PMC11106447 DOI: 10.3389/fendo.2024.1364585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Aim To evaluate the efficacy and safety of URLi (ultra rapid lispro insulin) compared to insulin lispro as bolus insulin with basal insulin using CGM in the individuals with type 2 diabetes(T2D) in China. Methods This was a double-blind, randomized, parallel, prospective, phase 3 study. Subjects with uncontrolled T2D were recruited and randomized 1:2 into the insulin lispro and URLi groups. Subjects received a consistent basal insulin regimen during the study and self-administered insulin lispro or URLi before each meal throughout the treatment period. Subjects underwent a 3-day continuous glucose monitoring (CGM) at the baseline and endpoint respectively, and then CGM data were analyzed. The primary endpoint was to compare the difference in postprandial glucose (PPG) control using CGM between the two groups. Results A total of 57 subjects with T2D completed the study. Our CGM data showed that postprandial glucose excursions after breakfast (BPPGE) in the URLi group was lower than that in the insulin lispro group (1.59 ± 1.57 mmol/L vs 2.51 ± 1.73 mmol/L, p = 0.046). 1-hour PPG was observed to decrease more in the URLi group than that in the insulin lispro group (-1.37 ± 3.28 mmol/L vs 0.24 ± 2.58 mmol/L, p = 0.047). 2-hour PPG was observed to decrease more in the URLi group than that in the insulin lispro group (-1.12 ± 4.00 mmol/L vs 1.22 ± 2.90 mmol/L, p = 0.021). The mean HbA1c level decreased by 1.1% in the URLi group and 0.99% in the insulin lispro group, with no treatment difference (p = 0.642). In the CGM profile, TBR was not significantly different between the two groups (p = 0.743). The weight gain also did not differ between the two groups (p = 0.303). Conclusion URLi can control breakfast PPG better than insulin lispro in adults with T2D in China, while it is non-inferior in improving HbA1c. The incidence of hypoglycemic and weight gain were similar between the two groups.
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Affiliation(s)
| | | | | | | | | | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jindan Wu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Bombaci B, Passanisi S, Pecoraro M, Sorrenti L, Papa M, Salzano G, Lombardo F. Use of teplizumab in children and adolescents at risk of type 1 diabetes: perspectives of parents and caregivers from an Italian Pediatric Diabetes Center. Acta Diabetol 2024; 61:635-642. [PMID: 38381182 DOI: 10.1007/s00592-024-02245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
AIMS In view of the imminent introduction of a novel category of disease-modifying treatments for type 1 diabetes (T1D) in European countries, it becomes imperative to understand the existing awareness and viewpoints of parents and caregivers of children and adolescents predisposed to T1D. This study aims to evaluate the perspectives of a cohort of parents and caregivers regarding using teplizumab to delay the onset of T1D in predisposed children and adolescents. METHODS This single-center study used a survey-based approach. Parents or caregivers of children and adolescents with T1D having at least one additional child without T1D answered 15 questions assessing their awareness about teplizumab, their potential willingness to provide consent for its administration in case of eligibility, and their expectations regarding potential outcomes. RESULTS Approximately half of the participants (52.6%) expressed readiness to consent to teplizumab administration for their child if the prescription criteria were met in the future. Only 6.3% of parents claimed detailed knowledge about this innovative medication. Notably, parents with prior experience of diabetic ketoacidosis (DKA) demonstrated a higher inclination to consent to teplizumab treatment (p = 0.018). CONCLUSIONS Our findings underscore the necessity for comprehensive awareness campaigns spreading the current evidence concerning teplizumab in terms of both effectiveness and possible side effects. Additionally, our study reinforces the pivotal role of DKA prevention in successfully integrating disease-modifying treatments into clinical practice.
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Affiliation(s)
- Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy.
| | - Maria Pecoraro
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Lacrima Sorrenti
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Mattia Papa
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
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Maia A, Subias Andujar D, Yuste C, Albert L, Vilaverde J, Cardoso MH, Rigla M. Time in Range Analysis in Automated Insulin Delivery Era: Should Day and Nighttime Targets be the Same? J Diabetes Sci Technol 2024:19322968241236456. [PMID: 38501504 DOI: 10.1177/19322968241236456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Hybrid closed-loop systems (HCLS) use has shown that time in range (TIR) tends to improve more during the nighttime than during the day. This study aims to compare the conventional TIR, currently accepted as 70 to 180 mg/dL, with a proposed recalculated time in range (RTIR) considering a tighter glucose target of 70 to 140 mg/dL for the nighttime fasting period in T1DM patients under HCLS. METHODS We conducted a retrospective study that included adults patients receiving treatment with Tandem t:slim X2 Control-IQ. Daytime TIR was characterized as glucose values between 70 and 180 mg/dL during the 07:01 to 23:59 time frame. Nighttime fasting TIR was specified as glucose values from 70 to 140 mg/dL between 00:00 and 07:00. The combination of the daytime and nighttime fasting glucose targets results in an RTIR, which was compared with the conventional TIR for each patient. The 14 days Dexcom G6 CGM data were downloaded from Tidepool platform and analyzed. RESULTS We included 22 patients with a mean age of 49.7 years and diabetes duration of 24.7 years, who had been using automatic insulin delivery (AID) HCLS for a median of 305.3 days. We verified a mean conventional TIR of 68.7% vs a mean RTIR of 60.3%, with a mean percentage difference between these two metrics of -8.4%. A significant decrease in conventional TIR was verified when tighter glucose targets were considered during the nighttime period. No significant correlation was found between the percentage difference values and RTIR, even among the group of patients with the lowest conventional TIR. CONCLUSIONS Currently, meeting the conventional TIR metrics may fall short of achieving an ideal level of glycemic control. An individualized strategy should be adopted until further data become available for a precise definition of optimal glucose targets.
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Affiliation(s)
- Ariana Maia
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - David Subias Andujar
- Endocrinology Department, Parc Taulí Hospital Universitari, Sabadell, Spain
- Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Cristina Yuste
- Endocrinology Department, Parc Taulí Hospital Universitari, Sabadell, Spain
- Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Lara Albert
- Endocrinology Department, Parc Taulí Hospital Universitari, Sabadell, Spain
- Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Joana Vilaverde
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Maria Helena Cardoso
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Mercedes Rigla
- Endocrinology Department, Parc Taulí Hospital Universitari, Sabadell, Spain
- Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
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Akturk HK, Battelino T, Castañeda J, Arrieta A, van den Heuvel T, Cohen O. Future of Time-in-Range Goals in the Era of Advanced Hybrid Closed-Loop Automated Insulin Delivery Systems. Diabetes Technol Ther 2024; 26:102-106. [PMID: 38377325 PMCID: PMC10890947 DOI: 10.1089/dia.2023.0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The concept of maintaining blood glucose levels within the 70-180 mg/dL range, known as time-in-range, has raised questions regarding its representation of true physiological euglycemia. Some have speculated that focusing on the time spent within the 70-140 mg/dL range, introduced as time in tight range (TITR) through the International Consensus statement, could serve as a more precise metric for assessing normoglycemia in individuals with type 1 diabetes. This article delves into the current status of TITR as an emerging marker and explores how advanced hybrid closed-loop systems may offer a promising avenue for achieving this higher level of glycemic control.
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Affiliation(s)
- Halis K. Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, Colorado, USA
| | - Tadej Battelino
- University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Arcelia Arrieta
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | | | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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Dunn TC, Ajjan RA, Bergenstal RM, Xu Y. Is It Time to Move Beyond TIR to TITR? Real-World Data from Over 20,000 Users of Continuous Glucose Monitoring in Patients with Type 1 and Type 2 Diabetes. Diabetes Technol Ther 2024; 26:203-210. [PMID: 38444315 PMCID: PMC10877396 DOI: 10.1089/dia.2023.0565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The growing use of continuous glucose monitoring (CGM) has been supported by expert consensus and clinical guidelines on glycemic management in diabetes with time in range (TIR 70-180 mg/dL) representing a key CGM-derived glucose metric. Time in tight range (TITR) has also been proposed for clinical use, spanning largely normal glucose levels of 70-140 mg/dL. However, keeping such narrow glucose ranges can be challenging, and understanding the factors modulating TITR can help achieve these tight glycemic targets. Our real-life study aimed to evaluate the relationship between average glucose (AG) and TIR/TITR in a large cohort (n = 22,006) of CGM users, divided into four groups: self-identified as having type 1 diabetes (T1D) treated with insulin using multiple daily injections (MDI) or pumps; type 2 diabetes (T2D) on MDI or insulin pumps; T2D on basal insulin only; and T2D not on insulin treatment. The T2D groups, regardless of treatment type, displayed the highest TIR and TITR values, associated with lowest glycemic variability measured as glucose coefficient of variation (CV; 23-30%). The T1D group showed the lowest TIR and TITR, associated with the highest CVs (36-38%). Overall, higher CV was associated with lower TIR and TITR for AG values below 180 and 140 mg/dL, respectively, with the reverse holding true for AG values above these thresholds. The discordance between AG and TIR/TITR was less pronounced in T2D compared with T1D, attributed to lower CV in the former group. It was also observed that TITR has advantages over TIR for assessing glycemia status and progress toward more stringent A1C, particularly when approaching normal glucose levels. The data detail how CV affects the AG relationship with TIR/TITR, which has implications for CGM interpretation. In many instances TITR, rather than TIR, may be preferable to employ once AG falls below 140 mg/dL and near-normal glucose levels are required clinically.
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Affiliation(s)
- Timothy C. Dunn
- Clinical Affairs, Abbott Diabetes Care, Alameda, California, USA
| | - Ramzi A. Ajjan
- The LIGHT Laboratories, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Richard M. Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Yongjin Xu
- Clinical Affairs, Abbott Diabetes Care, Alameda, California, USA
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Foti Randazzese S, Bombaci B, Costantino S, Giorgianni Y, Lombardo F, Salzano G. Discordance between Glucose Management Indicator and Glycated Hemoglobin in a Pediatric Cohort with Type 1 Diabetes: A Real-World Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:210. [PMID: 38397323 PMCID: PMC10887365 DOI: 10.3390/children11020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024]
Abstract
The introduction of continuous glucose monitoring (CGM) systems in clinical practice has allowed a more detailed picture of the intra- and interdaily glycemic fluctuations of individuals with type 1 diabetes (T1D). However, CGM-measured glucose control indicators may be occasionally inaccurate. This study aims to assess the discrepancy between the glucose management indicator (GMI) and glycated hemoglobin (HbA1c) (ΔGMI-HbA1c) within a cohort of children and adolescents with T1D, exploring its correlation with other CGM metrics and blood count parameters. In this single-center, cross-sectional study, we gathered demographic and clinical data, including blood count parameters, HbA1c values, and CGM metrics, from 128 pediatric subjects with T1D (43% female; mean age, 13.4 ± 3.6 years). Our findings revealed higher levels of the coefficient of variation (CV) (p < 0.001) and time above range > 250 mg/dL (p = 0.033) among subjects with ΔGMI-HbA1c > 0.3%. No association was observed between blood count parameters and ΔGMI-HbA1c. In conclusion, despite the advancements and the widespread adoption of CGM systems, HbA1c remains an essential parameter for the assessment of glycemic control, especially in individuals with suboptimal metabolic control and extreme glycemic variability.
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Affiliation(s)
| | | | | | | | | | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy; (S.F.R.); (B.B.); (S.C.); (Y.G.); (F.L.)
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