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2. Does prepubertal youth with type 1 diabetes have maximum glucose variability?

      In a study published in Diabetes care, researchers have tried to evaluate glycemia and metrics of glucose variability in youth with type 1 diabetes, and to assess patterns of 24-h glucose variability according to pubertal status.

      Metrics of glycemia, glucose variability, and glucose patterns were evaluated for 4 weeks by continuous glucose monitoring (CGM) data from 107 youth aged 8–17 years with type 1 diabetes for ≥1 year. Glucose values per hour were expressed as percentages relative to the mean glucose over 24 h for a period of 4-weeks Glucose data were compared on the basis of pubertal status—prepubertal (Tanner stage [T] 1), pubertal (T2–4), and postpubertal (T5)—and A1C categories (<7.5%, ≥7.5%).

      The results from the study revealed that youth (50% female, 95% white) had a mean ± SD age of 13.1 ± 2.6 years, diabetes duration of 6.3 ± 3.5 years, and A1c of 7.8 ± 0.8%, 88% were pump treated. Prepubertal youth had a higher mean glucose SD (86 ± 12 mg/dL, P = 0.01) and coefficient of variation (CV) (43 ± 5%; P = 0.06) than did pubertal (SD 79 ± 13 mg/dL, CV 41 ± 5% and post-pubertal (SD 77 ± 14 mg/dL; CV 40 ± 5%) youth. Over 24 h, prepubertal youth had the largest excursions from mean glucose and the highest CV across most hours compared with pubertal and post-pubertal youth. Across all youth, CV was strongly correlated with the percentage of time with glucose <70 mg/dL (r = 0.79; P < 0.0001).

      The study concludes that prepubertal youth had greater glucose variability independent of A1C than did pubertal and post-pubertal youth. A1c alone does not capture the full range of glycemic parameters, highlighting the added insight of CGM in managing youth with type 1 diabetes.

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