OBJECTIVE
To evaluate whether indexes of glycemic variability may overcome residual b-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 b-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-effectsmodel. 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. b-Cell residual secretion estimates demonstrated weak-to-moderate correlations with clinical parametersand 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.