Impact of Real-Time Continuous Glucose Monitoring Use on Glucose Variability and Endothelial Function in Adolescents with Type 1 Diabetes: New Technology—New Possibility to Decrease Cardiovascular Risk?

Abstract

Children with type 1 diabetes (T1DM) are the high-risk group of accelerated atherosclerosis. Real-time continuous glucose monitoring (RT-CGM) provides possibilities for the detection of glycaemic variability, newly recognized cardiovascular risk factor. The aim of the study was to assess the usefulness of RT-CGM as an educational tool to find and reduce glycaemic variability in order to improve endothelial function in T1DM adolescents. Forty patients aged 14.6 years were recruited. The study was based on one-month CGM sensors use. Parameters of glycaemic variability were analyzed during first and last sensor use, together with brachial artery flow-mediated dilatation (FMD) to assess endothelial function. In the whole group, FMD improvement was found (10.9% to 16.6%, p < 0.005), together with decrease in all studied glycaemic variability parameters. In patients with HbA1c improvement compared to the group without HbA1c improvement, we found greater increase of FMD (12% to 19%, p < 0.005 versus 8.2% to 11.3%, p = 0.080) and greater improvement of glucose variability. RT-CGM can be considered as an additional tool that offers T1DM adolescents the quick reaction to decrease glycaemic variability in short time observation. Whether such approach might influence improvement in endothelial function and reduction of the risk of future cardiovascular disease remains to be elucidated.

Glycemic variability predicts inflammation in adolescents with type 1 diabetes

“…In a single group study Dal et al [32] found no effect of flexible insulin therapy designed to reduce glucose variability although mean amplitude glucose excursion also did not change. Jamiolkowska et al [40] found that reducing glucose variability improved endothelial function in adolescents with T1D.…”

Continuous glucose monitoring use and glucose variability in pre-school children with type 1 diabetes

“…Continuous glucose monitoring ( associated with a negative impact on brain volume and growth [4], and markers of cardiovascular morbidity [5] in children with type 1 diabetes, despite short disease duration. The use of CGM can reduce GV in adults and youth with type 1 diabetes [6,7], however, this has not yet been proven in preschool children.…”

Point-of-care testing in diabetes management

“…Additional benefits of CGMS are reducing daily fluctuations of glucose levels. Thus, glycemic variability in type 1 DM patients using insulin pumps and real-time glucose monitoring devices had an SD reduction from 60.74 to 51.67 mg/dl (p=0.010), and AUC diminished from 41.23 to 21.22 (p<0.001) (35). Moreover, a recent study showed that integrated pump/CGMS technology versus multiple daily injections in T1DM increases life expectancy by 3.51 years (95% CI, 3.47-3.55) (36).…”