Continuous glucose monitoring reduces pubertal hyperglycemia of type 1 diabetes

Benjamin Udoka Nwosu 1 , Shamima Yeasmin 2 , Sanaa Ayyoub 2 , Shwetha Rupendu 1 , Tony R. Villalobos-Ortiz 1 , Gabrielle Jasmin 1 , Sadichchha Parajuli 1 , Bita Zahedi 2 , Emily Zitek-Morrison 3 , Laura C. Alonso 4 ,  and Bruce A. Barton 3
  • 1 Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, USA
  • 2 Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, USA
  • 3 Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, USA
  • 4 Weill Cornell Division of Endocrinology, Diabetes and Metabolism, New York, USA
Benjamin Udoka Nwosu
  • Corresponding author
  • Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Email
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Shamima Yeasmin
  • Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Sanaa Ayyoub
  • Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Shwetha Rupendu
  • Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Tony R. Villalobos-Ortiz
  • Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Gabrielle Jasmin
  • Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Sadichchha Parajuli
  • Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Bita Zahedi
  • Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Emily Zitek-Morrison
  • Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Laura C. Alonso
  • Weill Cornell Division of Endocrinology, Diabetes and Metabolism, New York, NY, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
and Bruce A. Barton
  • Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar

Abstract

Background

Physiologic hyperglycemia of puberty is a major contributor to poor glycemic control in youth with type 1 diabetes (T1D). This study’s aim was to determine the effectiveness of continuous glucose monitoring (CGM) to improve glycemic control in pubertal youth with T1D compared to a non-CGM cohort after controlling for age, sex, BMI, duration, and insulin delivery methodology. The hypothesis is that consistent CGM use in puberty improves compliance with diabetes management, leading to increased percentage (%) time in range (TIR70–180 mg/dL) of glycemia, and lowering of HbA1c.

Methods

A longitudinal, retrospective, case-controlled study of 105 subjects consisting of 51 T1D controls (60.8% male) age 11.5 ± 3.8 y; and 54 T1D subjects (48.1% male) age 11.1 ± 5.0 y with confirmed CGM use for 12 months. Pubertal status was determined by Tanner staging. Results were adjusted for baseline HbA1c and diabetes duration.

Results

HbA1c was similar between the controls and the CGM group at baseline: 8.2 ± 1.1% vs 8.3 ± 1.2%, p=0.48 respectively; but was significantly lower in the CGM group 12 months later, 8.2 ± 1.1% vs. 8.7 ± 1.4%, p=0.035. Longitudinal change in HbA1c was similar in the prepubertal cohort between the control- and CGM groups: −0.17 ± 0.98% vs. 0.38 ± 1.5%, p=0.17. In contrast, HbA1c increased with advancing age and pubertal status in the pubertal controls but not in the pubertal CGM group: 0.55 ± 1.4 vs −0.22 ± 1.1%, p=0.020. Percent TIR was inversely related to HbA1c in the CGM group, r=-0.6, p=0.0004, for both prepubertal and pubertal subjects.

Conclusions

CGM use significantly improved glycemic control in pubertal youth with T1D compared to non-CGM users.

  • 1.

    Foster, NC, Beck, RW, Miller, KM, Clements, MA, Rickels, MR, DiMeglio, LA, et al. State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016-2018. Diabetes technology & therapeutics 2019;21:66–72. https://doi.org/10.1089/dia.2018.0384.

    • Crossref
    • PubMed
    • Export Citation
  • 2.

    Battelino, T, Danne, T, Bergenstal, RM, Amiel, SA, Beck, R, Biester, T, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care 2019;42:1593–603.

    • Crossref
    • PubMed
    • Export Citation
  • 3.

    Association AD Standards of Medical Care in Diabetes—2019. Diabetes Care.2019;42:S148–S64.

    • Crossref
    • PubMed
    • Export Citation
  • 4.

    Hamilton, J, Daneman, D. Deteriorating diabetes control during adolescence: physiological or psychosocial? J Pediatr Endocrinol Metab 2002;15:115–26. https://doi.org/10.1515/jpem.2002.15.2.115.

    • PubMed
    • Export Citation
  • 5.

    Moran, A, Jacobs, DRJr., Steinberger, J, Hong, CP, Prineas, R, Luepker, R, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes 1999;48:2039–44. https://doi.org/10.2337/diabetes.48.10.2039.

    • Crossref
    • PubMed
    • Export Citation
  • 6.

    Caprio, S. Insulin: the other anabolic hormone of puberty. Acta Paediatr Suppl. 1999;88:84–7. https://doi.org/10.1111/j.1651-2227.1999.tb14410.x.

    • Crossref
    • PubMed
    • Export Citation
  • 7.

    Clements, MA, Foster, NC, Maahs, DM, Schatz, DA, Olson, BA, Tsalikian, E, et al. Hemoglobin A1c (HbA1c) changes over time among adolescent and young adult participants in the T1D exchange clinic registry. Pediatr Diabetes. 2016;17:327–36. https://doi.org/10.1111/pedi.12295.

    • Crossref
    • Export Citation
  • 8.

    Plamper, M, Gohlke, B, Woelfle, J, Konrad, K, Rohrer, T, Hofer, S, et al. Interaction of Pubertal Development and Metabolic Control in Adolescents with Type 1 Diabetes Mellitus. J Diabetes Res 2017;2017. https://doi.org/10.1155/2017/8615769.

    • PubMed
    • Export Citation
  • 9.

    Amiel, SA, Sherwin, RS, Simonson, DC, Lauritano, AA, Tamborlane, WV. Impaired insulin action in puberty. A contributing factor to poor glycemic control in adolescents with diabetes. N Engl J Med 1986;315:215–9. https://doi.org/10.1056/nejm198607243150402.

    • PubMed
    • Export Citation
  • 10.

    Nadeau, KJ, Regensteiner, JG, Bauer, TA, Brown, MS, Dorosz, JL, Hull, A, et al. Insulin resistance in adolescents with type 1 diabetes and its relationship to cardiovascular function. J Clin Endocrinol Metab 2010;95:513–21. https://doi.org/10.1210/jc.2009-1756.

    • Crossref
    • PubMed
    • Export Citation
  • 11.

    Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. J Pediatr 1994;125:177–88.

  • 12.

    Willi, SM, Miller, KM, DiMeglio, LA, Klingensmith, GJ, Simmons, JH, Tamborlane, WV, et al. Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics 2015;135:424–34. https://doi.org/10.1542/peds.2014-1774.

    • Crossref
    • PubMed
    • Export Citation
  • 13.

    Redondo, MJ, Foster, NC, Libman, IM, Mehta, SN, Hathway, JM, Bethin, KE, et al. Prevalence of cardiovascular risk factors in youth with type 1 diabetes and elevated body mass index. Acta Diabetol 2015.

    • PubMed
    • Export Citation
  • 14.

    Dovc, K, Cargnelutti, K, Sturm, A, Selb, J, Bratina, N, Battelino, T. Continuous glucose monitoring use and glucose variability in pre-school children with type 1 diabetes. Diabetes Res Clin Pract 2019;147:76–80. https://doi.org/10.1016/j.diabres.2018.10.005.

    • Crossref
    • PubMed
    • Export Citation
  • 15.

    Bergenstal, RM, Garg, S, Weinzimer, SA, Buckingham, BA, Bode, BW, Tamborlane, WV, et al. Safety of a Hybrid Closed-Loop Insulin Delivery System in Patients With Type 1 Diabetes. JAMA 2016;316:1407–8. https://doi.org/10.1001/jama.2016.11708.

    • Crossref
    • PubMed
    • Export Citation
  • 16.

    Brown, SA, Kovatchev, BP, Raghinaru, D, Lum, JW, Buckingham, BA, Kudva, YC, et al. Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes. N Engl J Med 2019;381:1707–17. https://doi.org/10.1056/nejmoa1907863.

    • Crossref
    • PubMed
    • Export Citation
  • 17.

    Dadlani, V, Kaur, RJ, Stegall, M, Xyda, SE, Kumari, K, Bonner, K, et al. Continuous glucose monitoring to assess glycemic control in the first 6 weeks after pancreas transplantation. Clin Transplant. 2019;33:e13719. https://doi.org/10.1111/ctr.13719.

    • PubMed
    • Export Citation
  • 18.

    Maiorino, MI, Petrizzo, M, Bellastella, G, Esposito, K. Continuous glucose monitoring for patients with type 1 diabetes on multiple daily injections of insulin: pros and cons. Endocrine 2018;59:62–5. https://doi.org/10.1007/s12020-017-1328-z.

    • Crossref
    • PubMed
    • Export Citation
  • 19.

    American Diabetes A Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clinical diabetes : a publication of the American Diabetes Association 2017;35:5–26.

  • 20.

    Brix, N, Ernst, A, Lauridsen, LLB, Parner, E, Stovring, H, Olsen, J, et al. Timing of puberty in boys and girls: A population-based study. Paediatr Perinat Epidemiol 2019;33:70–8. https://doi.org/10.1111/ppe.12507.

    • Crossref
    • PubMed
    • Export Citation
  • 21.

    Nwosu, BU, Maranda, L. The effects of vitamin D supplementation on hepatic dysfunction, vitamin D status, and glycemic control in children and adolescents with vitamin D deficiency and either type 1 or type 2 diabetes mellitus. PLoS One 2014;9:e99646. https://doi.org/10.1371/journal.pone.0099646.

    • PubMed
    • Export Citation
  • 22.

    Lundberg, RL, Marino, KR, Jasrotia, A, Maranda, LS, Barton, BA, Alonso, LC, et al. Partial clinical remission in type 1 diabetes: a comparison of the accuracy of total daily dose of insulin of <0.3 units/kg/day to the gold standard insulin-dose adjusted hemoglobin A1c of </=9 for the detection of partial clinical remission. J Pediatr Endocrinol Metab 2017;30:823–30. https://doi.org/10.1515/jpem-2017-0019.

    • PubMed
    • Export Citation
  • 23.

    Nwosu, BU, Zhang, B, Ayyoub, SS, Choi, S, Villalobos-Ortiz, TR, Alonso, LC, et al. Children with type 1 diabetes who experienced a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis. PLoS One 2018;13:e0196912. https://doi.org/10.1371/journal.pone.0196912.

    • PubMed
    • Export Citation
  • 24.

    Veit, LE, Maranda, L, Fong, J, Nwosu, BU. The vitamin d status in inflammatory bowel disease. PLoS One 2014;9:e101583. https://doi.org/10.1371/journal.pone.0101583.

    • PubMed
    • Export Citation
  • 25.

    Marino, KR, Lundberg, RL, Jasrotia, A, Maranda, LS, Thompson, MJ, Barton, BA, et al. A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes. PLoS One 2017;12:e0176860. https://doi.org/10.1371/journal.pone.0176860.

    • PubMed
    • Export Citation
  • 26.

    Kuczmarski, RJ, Ogden, CL, Guo, SS, Grummer-Strawn, LM, Flegal, KM, Mei, Z, et al. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 2002;11:1–190.

  • 27.

    National Center for Health Statistics: https://www.cdc.gov/growthcharts/zscore.htm.

  • 28.

    Foster, NC, Miller, KM, Tamborlane, WV, Bergenstal, RM, Beck, RW, Network, TDEC. Continuous Glucose Monitoring in Patients With Type 1 Diabetes Using Insulin Injections. Diabetes Care 2016;39:e81–2. https://doi.org/10.2337/dc16-0207.

    • Crossref
    • PubMed
    • Export Citation
  • 29.

    Beck, RW, Riddlesworth, T, Ruedy, K, Ahmann, A, Bergenstal, R, Haller, S, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. JAMA 2017;317371–8. https://doi.org/10.1001/jama.2016.19975.

    • Crossref
    • PubMed
    • Export Citation
  • 30.

    Lind, M, Polonsky, W, Hirsch, IB, Heise, T, Bolinder, J, Dahlqvist, S, et al. Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections: The GOLD Randomized Clinical Trial. JAMA 2017;317:379–87. https://doi.org/10.1001/jama.2016.19976.

    • Crossref
    • PubMed
    • Export Citation
  • 31.

    van Beers, CA, DeVries, JH, Kleijer, SJ, Smits, MM, Geelhoed-Duijvestijn, PH, Kramer, MH, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial. The lancet Diabetes & endocrinology 2016;4:893–902. https://doi.org/10.1016/s2213-8587(16)30193-0.

    • Crossref
    • PubMed
    • Export Citation
  • 32.

    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study G, Beck, RW, Hirsch, IB, Laffel, L, Tamborlane, WV, Bode, BW, et al. The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care 2009;32:1378–83.

    • Crossref
    • PubMed
    • Export Citation
  • 33.

    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study G, Beck, RW, Buckingham, B, Miller, K, Wolpert, H, Xing, D, et al. Factors predictive of use and of benefit from continuous glucose monitoring in type 1 diabetes. Diabetes Care 2009;32:1947–53.

    • Crossref
    • PubMed
    • Export Citation
  • 34.

    Beck, RW, Bergenstal, RM, Cheng, P, Kollman, C, Carlson, AL, Johnson, ML, et al. The Relationships Between Time in Range, Hyperglycemia Metrics, and HbA1c. Journal of diabetes science and technology 2019;13:614–26. https://doi.org/10.1177/1932296818822496.

    • Crossref
    • PubMed
    • Export Citation
  • 35.

    Vigersky, RA, McMahon, C. The Relationship of Hemoglobin A1C to Time-in-Range in Patients with Diabetes. Diabetes technology & therapeutics 2019;21:81–5. https://doi.org/10.1089/dia.2018.0310.

    • Crossref
    • PubMed
    • Export Citation
  • 36.

    Pickup, JC, Freeman, SC, Sutton, AJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ 2011;343. https://doi.org/10.1136/bmj.d3805.

    • PubMed
    • Export Citation
  • 37.

    Channon, S, Smith, VJ, Gregory, JW. A pilot study of motivational interviewing in adolescents with diabetes. Arch Dis Child 2003;88:680–3. https://doi.org/10.1136/adc.88.8.680.

    • Crossref
    • PubMed
    • Export Citation
  • 38.

    Viner, RM, Christie, D, Taylor, V, Hey, S. Motivational/solution-focused intervention improves HbA1c in adolescents with Type 1 diabetes: a pilot study. Diabet Med 2003;20:739–42. https://doi.org/10.1046/j.1464-5491.2003.00995.x.

    • Crossref
    • PubMed
    • Export Citation
  • 39.

    Holmes-Walker, DJ, Llewellyn, AC, Farrell, K. A transition care programme which improves diabetes control and reduces hospital admission rates in young adults with Type 1 diabetes aged 15-25 years. Diabet Med 2007;24:764–9. https://doi.org/10.1111/j.1464-5491.2007.02152.x.

    • Crossref
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

The Journal of Pediatric Endocrinology and Metabolism (JPEM) is the only international journal dedicated exclusively to endocrinology in the neonatal, pediatric and adolescent age groups, and publishes the results of clinical investigations in pediatric endocrinology and basic research. JPEM publishes Review Articles, Original Research, Case Reports, Short Communications and Letters to the Editor.

Search