Continuous Glucose Monitoring in Adults With Type 1 Diabetes With 35 Years Duration From the DCCT/EDIC Study

Authors

Rose A. Gubitosi-Klug, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH.
Barbara H. Braffett, Biostatistics Center, George Washington University, Rockville, MD.
Ionut Bebu, Biostatistics Center, George Washington University, Rockville, MD.
Mary L. Johnson, International Diabetes Center, Minneapolis, MN.
Kaleigh Farrell, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH.
David Kenny, Biostatistics Center, George Washington University, Rockville, MD.
Victoria R. Trapani, Biostatistics Center, George Washington University, Rockville, MD.
Lynne Meadema-Mayer, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH.
Elsayed Z. Soliman, Wake Forest School of Medicine, Winston-Salem, NC.
Rodica Pop-Busui, University of Michigan, Ann Arbor, MI.
John M. Lachin, Biostatistics Center, George Washington University, Rockville, MD.
Richard M. Bergenstal, International Diabetes Center, Minneapolis, MN.
William V. Tamborlane, Yale University, New Haven, CT.

Document Type

Journal Article

Publication Date

3-1-2022

Journal

Diabetes care

Volume

45

Issue

3

DOI

10.2337/dc21-0629

Abstract

OBJECTIVE: We evaluated blinded continuous glucose monitoring (CGM) profiles in a subset of adults with type 1 diabetes from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study to characterize the frequency of glycemic excursions and contributing factors. RESEARCH DESIGN AND METHODS: CGM-derived metrics were compared for daytime and nighttime periods using blinded CGM for a minimum of 6.5 days (average 11.9 days) and correlated with HbA1c levels, routine use of diabetes devices, and other characteristics in 765 participants. RESULTS: Participants were 58.9 ± 6.5 years of age with diabetes duration 36.8 ± 4.9 years and HbA1c 7.8 ± 1.2%; 58% used insulin pumps, and 27% used personal, unblinded CGM. Compared with daytime, nighttime mean sensor glucose was lower, percent time in range 70-180 mg/dL (TIR) was similar, and hypoglycemia was more common. Over the entire recording period, only 9% of the 765 participants achieved >70% TIR and only 28% achieved <1% of observations of <54 mg/dL. Indeed, participants with the highest percentage of hypoglycemia had the lowest HbA1c levels. However, use of insulin pumps and CGM decreased the percent time at <54 mg/dL. CONCLUSIONS: In adults with long-standing type 1 diabetes, short-term blinded CGM profiles revealed frequent clinically significant hypoglycemia (<54 mg/dL) during the night and more time in hyperglycemia during the day. The small subset of participants using routine CGM and insulin pumps had fewer hypoglycemic and hyperglycemic excursions and lower HbA1c levels. Thus, strategies to lower meal-stimulated hyperglycemia during the day and prevent hypoglycemia at night are relevant clinical goals in older patients with type 1 diabetes.

APA Citation

Gubitosi-Klug, Rose A.; Braffett, Barbara H.; Bebu, Ionut; Johnson, Mary L.; Farrell, Kaleigh; Kenny, David; Trapani, Victoria R.; Meadema-Mayer, Lynne; Soliman, Elsayed Z.; Pop-Busui, Rodica; Lachin, John M.; Bergenstal, Richard M.; and Tamborlane, William V., "Continuous Glucose Monitoring in Adults With Type 1 Diabetes With 35 Years Duration From the DCCT/EDIC Study" (2022). GW Authored Works. Paper 660.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/660

Department

Epidemiology