medwireNews: Prepubertal children with type 1 diabetes have greater glycemic variability than those who are pubertal or postpubertal, researchers have reported at the ADA’s 78th Scientific Sessions.
And this increased variability is associated with more time spent in hypoglycemia, Jia Zhu (Boston Children’s Hospital, Massachusetts, USA) told delegates in Orlando, Florida.
Her team looked at 4 weeks of continuous glucose monitoring (CGM) data in 107 children aged an average of 13.1 years, with an average diabetes duration of 6.3 years. Overall, these children spent 45% of their time with normal glucose levels, 3% in hypoglycemia, and 51% in hyperglycemia.
The 26% of children who were prepubertal had similar glycated hemoglobin levels to the 40% who were pubertal and the 34% who were post-pubertal, and the same was true for average glucose levels. However, the standard deviation of glucose levels and the coefficient of variation (CV) were significantly higher in the prepubertal children than in the other two groups.
When the researchers looked at 24-hour glucose profiles they noted that the prepubertal children had more pronounced peaks and troughs than the other children; in particular, they had a significantly larger fall in overnight glucose levels.
Zhu noted that a glucose CV greater than 36% has been associated with increased hypoglycemia and the same was true in this study. The 80% of children with a glucose CV greater than 36% spent 4% of their time in the hypoglycemic range, which was significantly more than the 1% of time spent by those with a lower glucose CV. There was a significant correlation between glucose CV and time in hypoglycemia in all the children, although the association was strongest in the prepubertal group.
The findings highlight the value of CGM for identifying patterns of glycemic variation, said Zhu.
“Understanding the patterns of glycemic variation according to pubertal status can serve as a guide for timely insulin adjustments,” she concluded, although she stressed that reducing glycemic variability is likely to reduce hypoglycemia risk irrespective of pubertal status.
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