Advanced and Specialized Nursing; Endocrinology, Diabetes and Metabolism; Internal Medicine
Abstract :
[en] OBJECTIVE
To evaluate whether indexes of glycemic variability may overcome residual β-cell secretion estimates in the longitudinal evaluation of partial remission in a cohort of pediatric patients with new-onset type 1 diabetes.
RESEARCH DESIGN AND METHODS
Values of residual β-cell secretion estimates, clinical parameters (e.g., HbA1c or insulin daily dose), and continuous glucose monitoring (CGM) from 78 pediatric patients with new-onset type 1 diabetes were longitudinally collected during 1 year and cross-sectionally compared. Circadian patterns of CGM metrics were characterized and correlated to remission status using an adjusted mixed-effects model. Patients were clustered based on 46 CGM metrics and clinical parameters and compared using nonparametric ANOVA.
RESULTS
Study participants had a mean (± SD) age of 10.4 (± 3.6) years at diabetes onset, and 65% underwent partial remission at 3 months. β-Cell residual secretion estimates demonstrated weak-to-moderate correlations with clinical parameters and CGM metrics (r2 = 0.05–0.25; P < 0.05). However, CGM metrics strongly correlated with clinical parameters (r2 >0.52; P < 0.05) and were sufficient to distinguish remitters from nonremitters. Also, CGM metrics from remitters displayed specific early morning circadian patterns characterized by increased glycemic stability across days (within 63–140 mg/dL range) and decreased rate of grade II hypoglycemia (P < 0.0001) compared with nonremitters. Thorough CGM analysis allowed the identification of four novel glucotypes (P < 0.001) that segregate patients into subgroups and mirror the evolution of remission after diabetes onset.
CONCLUSIONS
In our pediatric cohort, combination of CGM metrics and clinical parameters unraveled key clinical milestones of glucose homeostasis and remission status during the first year of type 1 diabetes.
Disciplines :
Endocrinology, metabolism & nutrition Pediatrics
Author, co-author :
Pollé, Olivier G.; 1Pôle de PEDI, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium ; 2Specialized Pediatrics Service, Cliniques Universitaires Saint-Luc, Brussels, Belgium ; DIATAG Working Group
Delfosse, Antoine; 1Pôle de PEDI, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium ; 2Specialized Pediatrics Service, Cliniques Universitaires Saint-Luc, Brussels, Belgium ; DIATAG Working Group
Martin, Manon; 3Computational Biology and Bioinformatics Unit, de Duve Institute, UCLouvain, Brussels, Belgium ; DIATAG Working Group
Louis, Jacques; 4Division of Pediatric Endocrinology, Department of Pediatrics, Grand Hôpital de Charleroi, Charleroi, Belgium ; DIATAG Working Group
Gies, Inge; 5Division of Pediatric Endocrinology, Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium ; 6Research Group GRON, Vrije Universiteit Brussel, Brussels, Belgium ; DIATAG Working Group
den Brinker, Marieke ; 7Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium ; 8Division of Pediatric Endocrinology, Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium ; DIATAG Working Group
Seret, Nicole; 9Division of Pediatric Endocrinology, Department of Pediatrics, Centre Hospitalier Chrétien MontLégia, Liège, Belgium ; DIATAG Working Group
Lebrethon, Marie-Christine ; Centre Hospitalier Universitaire de Liège - CHU > > Service de pédiatrie ; DIATAG Working Group
Mouraux, Thierry; 11Division of Pediatric Endocrinology, Department of Pediatrics, CHU Namur, Namur, Belgium ; DIATAG Working Group
Gatto, Laurent; 3Computational Biology and Bioinformatics Unit, de Duve Institute, UCLouvain, Brussels, Belgium ; DIATAG Working Group
Lysy, Philippe A. ; 1Pôle de PEDI, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium ; 2Specialized Pediatrics Service, Cliniques Universitaires Saint-Luc, Brussels, Belgium ; DIATAG Working Group
Other collaborator :
Parent, Anne-Simone ; Centre Hospitalier Universitaire de Liège - CHU > > Service de pédiatrie ; DIATAG Working Group
Language :
English
Title :
Glycemic Variability Patterns Strongly Correlate With Partial Remission Status in Children With Newly Diagnosed Type 1 Diabetes
BESPEED - Belgian Society for Pediatric Endocrinology and Diabetology [BE] FRIA - Fonds pour la Formation à la Recherche dans l'Industrie et dans l'Agriculture [BE] F.R.S.-FNRS - Fonds de la Recherche Scientifique [BE] SFD - Société Francophone du Diabète [FR]
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