CGM Metrics Identify Dysglycemic States in Participants From the TrialNet Pathway to Prevention Study

• DOI: 10.2337/dc22-1297
• Publication Date: 2023-02-02T19:09:15Z
• Authors: Darrell M. Wilson; Susan L. Pietropaolo; Maria Acevedo-Calado; Shuai Huang; Destiny Anyaiwe; David Scheinker; Andrea K. Steck; Madhuri M. Vasudevan; Siripoom V. McKay; Jennifer L. Sherr; Kevan C. Herold; Jessica L. Dunne; Carla J. Greenbaum; Sandra M. Lord; Michael J. Haller; Desmond A. Schatz; Mark A. Atkinson; Patrick W. Nelson; Massimo Pietropaolo
• Keywords: Male; Blood Glucose; 03 medical and health sciences; Diabetes Mellitus, Type 1; Glucose; 0302 clinical medicine; Adolescent; Blood Glucose Self-Monitoring; Humans; Female; Autoantibodies

OBJECTIVEContinuous glucose monitoring (CGM) parameters may identify individuals at risk for progression to overt type 1 diabetes. We aimed to determine whether CGM metrics provide additional insights into progression to clinical stage 3 type 1 diabetes.RESEARCH DESIGN AND METHODSOne hundred five relatives of individuals in type 1 diabetes probands (median age 16.8 years; 89% non-Hispanic White; 43.8% female) from the TrialNet Pathway to Prevention study underwent 7-day CGM assessments and oral glucose tolerance tests (OGTTs) at 6-month intervals. The baseline data are reported here. Three groups were evaluated: individuals with 1) stage 2 type 1 diabetes (n = 42) with two or more diabetes-related autoantibodies and abnormal OGTT; 2) stage 1 type 1 diabetes (n = 53) with two or more diabetes-related autoantibodies and normal OGTT; and 3) negative test for all diabetes-related autoantibodies and normal OGTT (n = 10).RESULTSMultiple CGM metrics were associated with progression to stage 3 type 1 diabetes. Specifically, spending ≥5% time with glucose levels ≥140 mg/dL (P = 0.01), ≥8% time with glucose levels ≥140 mg/dL (P = 0.02), ≥5% time with glucose levels ≥160 mg/dL (P = 0.0001), and ≥8% time with glucose levels ≥160 mg/dL (P = 0.02) were all associated with progression to stage 3 disease. Stage 2 participants and those who progressed to stage 3 also exhibited higher mean daytime glucose values; spent more time with glucose values over 120, 140, and 160 mg/dL; and had greater variability.CONCLUSIONSCGM could aid in the identification of individuals, including those with a normal OGTT, who are likely to rapidly progress to stage 3 type 1 diabetes.