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. 2019 Aug 1;104(8):3337-3344.
doi: 10.1210/jc.2018-02196.

Continuous Glucose Monitoring Predicts Progression to Diabetes in Autoantibody Positive Children

Andrea K Steck  1 , Fran Dong  1 , Iman Taki  1 , Michelle Hoffman  1 , Kimber Simmons  1 , Brigitte I Frohnert  1 , Marian J Rewers  1
Affiliations

Continuous Glucose Monitoring Predicts Progression to Diabetes in Autoantibody Positive Children

Andrea K Steck et al. J Clin Endocrinol Metab. .

Abstract

Context: Accurate measures are needed for the prediction and diagnosis of type 1 diabetes (T1D) in at-risk persons.

Objective: The purpose of this study was to explore the value of continuous glucose monitoring (CGM) in predicting T1D onset.

Design and setting: The Diabetes Autoimmunity Study in the Young (DAISY) prospectively follows children at increased risk for development of islet autoantibodies (islet autoantibody positive; Ab+) and T1D.

Participants: We analyzed 23 Ab+ participants with available longitudinal CGM data.

Main outcome measure: CGM metrics as glycemic predictors of progression to T1D.

Results: Of 23 Ab+ participants with a baseline CGM, 8 progressed to diabetes at a median age of 13.8 years during a median follow-up of 17.7 years (interquartile range, 14.6 to 22.0 years). Compared with nonprogressors, participants who progressed to diabetes had significantly increased baseline glycemic variability (SD, 29 vs 21 mg/dL; P = 0.047), daytime sensor average (122 vs 106 mg/dL; P = 0.02), and daytime sensor area under the curve (AUC, 470,370 vs 415,465; P = 0.047). They spent 24% of time at >140 mg/dL and 12% at >160 mg/dL compared with, respectively, 8% and 3% for nonprogressors (both P = 0.005). A receiver-operating characteristic curve analysis showed an AUC of 0.85 for percentage of time spent at >140 or 160 mg/dL. The cutoff of 18% time spent at >140 mg/dL had 75% sensitivity, 100% specificity, and a 100% positive predictive value for diabetes prediction, although these values could change because some nonprogressors may develop diabetes with longer follow-up.

Conclusions: Eighteen percent or greater CGM time spent at >140 mg/dL predicts progression to diabetes in Ab+ children.

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Figures

Figure 1.
Figure 1.
CGM percentage of time at >140 mg/dL over time between progressors and nonprogressors. Time is shown as years after seroconversion [i.e. years after participants were confirmed to have persistent islet autoantibodies (≥2 consecutive Ab+ visits)]. *A total of seven participants (three progressors and four nonprogressors) had CGM done only once at the time of these analyses.
Figure 2.
Figure 2.
CGM percentage of time at >140 mg/dL (A) and HbA1c (B) over time between progressors and nonprogressors. Time is shown as years before last visit (i.e., years before last visit in DAISY for nonprogressors and years before T1D onset for progressors). Among progressors, the participant with <1% of time at >140 mg/dL on the graph was diagnosed 19 months after his last CGM, with an HbA1c of 6.9% (no CGM or OGTT was done close to diagnosis). Of note, the nonprogressor participant with a low HbA1c (∼3.5%) has a hemoglobinopathy. *A total of seven participants (three progressors and four nonprogressors) had CGM done only once at the time of these analyses, whereas six participants (three progressors and three nonprogressors) had only one HbA1c result at the time of these analyses.
Figure 3.
Figure 3.
“Typical” CGM profiles of DAISY participants with <10% of time and >10% of time above 140 mg/dl. (A) CGM tracing with 4% of time at >140 mg/dL and 96% of time at target (60 to 140 mg/dL). (B) CGM tracing with 18% of time at >140 mg/dL and 82% of time at target (60 to 140 mg/dL). Each color/shape represents a different day.
See this image and copyright information in PMC

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