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

Sherr, Jennifer; Tamborlane, William V.; Xing, Dongyuan; Tsalikian, Eva; Mauras, Nelly; Buckingham, Bruce A.; White, Neil H.; Arbeláez, Ana María; Beck, Roy W.; Kollman, Craig; Ruedy, Katrina J.

doi:10.2337/dc11-2190

Cited by 23 publications

(21 citation statements)

References 14 publications

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“…In that study, short-term glucose variability assessed with continuous glucose monitoring system (CGMS) was associated with postprandial beta cell function. Another reported that glucose variability was significantly reduced in youth with short-term type 1 diabetes who retained residual β-cell function than in youth with type 1 diabetes for a longer duration [19]. However, we could not find the studies showing relationships between A1C variability and β-cell function at the time of diagnosis in type 2 diabetes.…”

Section: Discussioncontrasting

confidence: 53%

Relationships of A1c Variability for 10 Years and Beta Cell Function at the Time of Diagnosis in Type 2 Diabetes

Park¹

2015

General Med

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Background: Recent several reports emphasized A1c variability along with average blood glucose determined by Alc. Many studies have been showing the relationship of A1c variability with chronic diabetic complications. But, associations between patterns or degrees of A1c variability and influential factors have not been studied much. Therefore, this study aimed to evaluate the relationships of A1c variability for 10 years and beta cell function at the time of diagnosis in type 2 diabetes in clinical practice.

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Section: Discussioncontrasting

confidence: 53%

Relationships of A1c Variability for 10 Years and Beta Cell Function at the Time of Diagnosis in Type 2 Diabetes

Park¹

2015

General Med

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“…In the DCCT, maintaining residual C-peptide secretion was associated with a significant decrease in the incidence of severe hypoglycaemia [13]. In a previous study, a good correlation of residual C-peptide secretion with a lower incidence of hypoglycaemic readings on CGM was demonstrated [14]. In that study, 16 participants with recently diagnosed diabetes and measurable C-peptide levels (mean 0.96 ± 0.42 pmol/ml, ranging from 0.46 to 1.96 pmol/ml) had a 0.3% incidence of hypoglycaemia, and a group of individuals with a mean duration of diabetes of 7.6 years and who had similar HbA 1c levels (6.8% [51 mmol/mol]) had a 7.6% incidence of hypoglycaemia.…”

Section: Discussionmentioning

confidence: 99%

“…In that study, 16 participants with recently diagnosed diabetes and measurable C-peptide levels (mean 0.96 ± 0.42 pmol/ml, ranging from 0.46 to 1.96 pmol/ml) had a 0.3% incidence of hypoglycaemia, and a group of individuals with a mean duration of diabetes of 7.6 years and who had similar HbA 1c levels (6.8% [51 mmol/mol]) had a 7.6% incidence of hypoglycaemia. Of interest, in that study an age-matched control group had 1.7% of their CGM readings < 3.9 mmol/l despite not having diabetes [14], which may be a result of false hypoglycaemic readings obtained with the CGM, which was the same CGM system as used in the current study. In the current study, 76% of CGM downloads from study participants, more than 10% of whom had CGM readings < 3.9 mmol/l, showed significant residual C-peptide levels of 0.57–3.08 pmol/ml resulting in findings of a positive correlation between increased C-peptide levels and a higher incidence of hypoglycaemia.…”

Section: Discussionmentioning

confidence: 99%

CGM-measured glucose values have a strong correlation with C-peptide, HbA1c and IDAAC, but do poorly in predicting C-peptide levels in the two years following onset of diabetes

Buckingham

Cheng²,

Beck

et al. 2015

Diabetologia

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Aims/hypothesis The aim of this work was to assess the association between continuous glucose monitoring (CGM) data, HbA1c, insulin-dose-adjusted HbA1c (IDAA1c) and C-peptide responses during the first 2 years following diagnosis of type 1 diabetes. Methods A secondary analysis was conducted of data collected from a randomised trial assessing the effect of intensive management initiated within 1 week of diagnosis of type 1 diabetes, in which mixed-meal tolerance tests were performed at baseline and at eight additional time points through 24 months. CGM data were collected at each visit. Results Among 67 study participants (mean age [± SD] 13.3 ± 5.7 years), HbA1c was inversely correlated with C-peptide at each time point (p < 0.001), as were changes in each measure between time points (p < 0.001). However, C-peptide at one visit did not predict the change in HbA1c at the next visit and vice versa. Higher C-peptide levels correlated with increased proportion of CGM glucose values between 3.9 and 7.8 mmol/l and lower CV (p = 0.001 and p=0.02, respectively) but not with CGM glucose levels < 3.9 mmol/l. Virtually all participants with IDAA1c < 9 retained substantial insulin secretion but when evaluated together with CGM, time in the range of 3.9–7.8 mmol/l and CV did not provide additional value in predicting C-peptide levels. Conclusions/interpretation In the first 2 years after diagnosis of type 1 diabetes, higher C-peptide levels are associated with increased sensor glucose levels in the target range and with lower glucose variability but not hypoglycaemia. CGM metrics do not provide added value over the IDAA1c in predicting C-peptide levels.

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“…Patients in the non-RBF group may have higher glucose variability (34), making it difficult to increase the insulin dose.…”

Section: Discussionmentioning

confidence: 99%

Residual β-Cell Function 3–6 Years After Onset of Type 1 Diabetes Reduces Risk of Severe Hypoglycemia in Children and Adolescents

et al. 2013

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OBJECTIVETo determine the prevalence of residual β-cell function (RBF) in children after 3–6 years of type 1 diabetes, and to examine the association between RBF and incidence of severe hypoglycemia, glycemic control, and insulin requirements.RESEARCH DESIGN AND METHODSA total of 342 children (173 boys) 4.8–18.9 years of age with type 1 diabetes for 3–6 years were included. RBF was assessed by testing meal-stimulated C-peptide concentrations. Information regarding severe hypoglycemia within the past year, current HbA1c, and daily insulin requirements was retrieved from the medical records and through patient interviews.RESULTSNinety-two children (27%) had RBF >0.04 nmol/L. Patients with RBF <0.04 nmol/L were significantly more likely to have severe hypoglycemia than patients with RBF >0.04 nmol/L (odds ratio, 2.59; 95% CI, 1.10–7.08; P < 0.03). HbA1c was significantly higher in patients with RBF <0.04 nmol/L compared with patients with RBF >0.04 nmol/L (mean, 8.49 ± 0.08% [69.3 ± 0.9 mmol/mol] vs. 7.92 ± 0.13% [63.1 ± 1.4 mmol/mol]; P < 0.01), and insulin requirements were significantly lower in patients with RBF >0.2 nmol/L (mean ± SE: 1.07 ± 0.02 vs. 0.93 ± 0.07 units/kg/day; P < 0.04).CONCLUSIONSWe demonstrated considerable phenotypic diversity in RBF among children after 3–6 years of type 1 diabetes. Children with RBF are at lower risk for severe hypoglycemia, have better diabetes regulation, and have lower insulin requirements compared with children without RBF. There appears to be a lower limit for stimulated RBF of ∼0.04 nmol/L that confers a beneficial effect on hypoglycemia and metabolic control.

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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

Cited by 23 publications

References 14 publications

Relationships of A1c Variability for 10 Years and Beta Cell Function at the Time of Diagnosis in Type 2 Diabetes

Relationships of A1c Variability for 10 Years and Beta Cell Function at the Time of Diagnosis in Type 2 Diabetes

CGM-measured glucose values have a strong correlation with C-peptide, HbA1c and IDAAC, but do poorly in predicting C-peptide levels in the two years following onset of diabetes

Residual β-Cell Function 3–6 Years After Onset of Type 1 Diabetes Reduces Risk of Severe Hypoglycemia in Children and Adolescents

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