Persistently high glucose levels in young children with type 1 diabetes

Abstract

Objectives To characterize glucose levels and variability in young children with T1D. Methods 144 children ages 4–10 diagnosed with T1D prior to age 8 were recruited at 5 DirecNet centers. Participants used a continuous glucose monitor (CGM) every 3 months during an 18-month study. Among the 144 participants, 135 (mean age 7.0 years, 47% female) had a minimum of 48 hours of CGM data at >5 out of 7 visits and were included in analyses. CGM metrics for different times of day were analyzed. Results Mean HbA1c at the beginning and end of the study was 7.9% (63 mmol/mol). Fifty percent of participants had glucose levels >180mg/dL (10.0 mmol/L) for >12 hours/day and >250 mg/dL (13.9 mmol/L) for >6 hours/day. Median time <70 mg/dL (3.9 mmol/L) was 66 minutes/day and <60 mg/dL (3.3 mmol/L) was 39 minutes/day. Mean amplitude of glycemic excursions (MAGE) was lowest overnight (12AM–6AM). The percent of CGM values 71–180 mg/dL (3.9–10.0 mmol/L) and the overall mean glucose correlated with HbA1c at all visits. There were no differences in CGM mean glucose or coefficient of variation between the age groups of 4–<6, 6–<8 and 8–<10. Conclusions Suboptimal glycemic control is common in young children with T1D as reflected by glucose levels in the hyperglycemic range for much of the day. New approaches to reduce postprandial glycemic excursions and increase time in the normal range for glucose in young children with T1D are critically needed. Glycemic targets in this age range should be revisited.

An alternative sensor-based method for glucose monitoring in children and young people with diabetes

“…This study, providing the first glucose variability data for a paediatric population in the UK, and others,7 13 14 17 21 36 show there is significant opportunity to improve glycaemic control in children and young people with diabetes. Several studies have associated improved outcomes with increased sensor wear 16–19.…”

Individual glucose responses to prolonged moderate intensity aerobic exercise in adolescents with type 1 diabetes: The higher they start, the harder they fall

“…The age of the cohort was 15 ± 2 years (mean ± SD), with an average duration of diabetes of 7 ± 4 years. The majority of adolescents were male (59%), on CSII (66%) in fair‐to‐poor glucose control, as measured by HbA 1c (8.2 ± 1.5%, 66 ± 12 mmol/mol), which is typical of this particular age range . The average dose of insulin was 0.62 ± 0.35 units per kilogram of body mass per day (U/kg/day).…”

“…This common practice also goes against recent guidelines on exercise management in T1D that recommend glycemia to be between 126 and 180 mg/dL before exercise start time . These recommendations may be a barrier to youth with T1D who frequently have elevated glucose concentrations after meal consumption, or because of reduced basal and/or bolus insulin doses in anticipation of physical activity . Surprisingly, very few studies have examined the glycemic responses to exercise in settings of pre‐exercise hyperglycemia.…”

Bolus Calculator Settings in Well-Controlled Prepubertal Children Using Insulin Pumps Are Characterized by Low Insulin to Carbohydrate Ratios and Short Duration of Insulin Action Time

“…The glycemic control in this study compares favorably with published data where the mean HbA1c in 4-to 10-year-old children was 7.9% (63 mmol/mol). 25 Limitations of this study include the retrospective design, the small number of patients, and the lack of a control group with longer DIA. However, the DIA in the pumps were adjusted after careful consideration of the experience of skillful parents, so a control group would not be within the scope of this study.…”