Clinical relevance of short-term glycemic variability in children and adolescents with type 1 diabetes: a narrative review

Abstract

Background and objective: In recent years, there has been growing interest in glycemic variability within the scientific community, particularly regarding its potential as an independent risk factor for diabetes-related long-term complications. This narrative review aimed to provide a comprehensive overview of short-term glycemic variability in children and adolescents with type 1 diabetes (T1D).

Methods: We performed a search of published literature on the PubMed MEDLINE database using the following combination of search terms: "glycemic variability", "pediatric", "type 1 diabetes", and "children".

Key content and findings: The widespread use of continuous glucose monitoring (CGM) systems has facilitated the characterization and quantification of glycemic fluctuations. Over the years, several metrics for assessing glycemic variability have been developed. Children and adolescents with T1D often experience wide and frequent glycemic excursions due to behavioral and hormonal factors. Several studies suggest a potential link between glycemic variability and an increased risk of diabetes-related complications.

Conclusions: Glycemic variability has become an integral aspect of the routine clinical management of youths with T1D, serving as a valuable therapeutic target. However, achieving recommended glycemic targets in this population remains challenging. Further long-term data are needed to definitively establish the role of glycemic variability in the development of complications.

Keywords: Complications; continuous glucose monitoring (CGM); insulin; pediatrics; time in range (TIR).

Figure 1

Graphical summary of assessment, associated factors, and long-term outcomes of glycemic variability in pediatric type 1 diabetes. The black, red, and green lines represent different patterns of glycemic variability over a 24-hour period. Specifically, the black line expresses a wide excursion of glucose levels, the red line indicates a moderate glucose variability, and the green line reflects a flat glucose profile. SD, standard deviation; CV, coefficient of variation; MAGE, mean amplitude of glycemic excursion; CONGA, continuous overlapping net glycemic action; MODD, mean of daily differences; HBGI, High Blood Glucose Index; LBGI, Low Blood Glucose Index.