CGM Metrics Predict Imminent Progression to Type 1 Diabetes: Autoimmunity Screening for Kids (ASK) Study
CGM Metrics Predict Imminent Progression to Type 1 Diabetes: Autoimmunity Screening for Kids (ASK) Study
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DOI：
10.2337/dc21-0602
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发表时间：
2022-02-01
期刊：
影响因子：
16.2
通讯作者：
ASK Study Grp
中科院分区：
文献类型：
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作者：
Steck, Andrea K.;Dong, Fran;ASK Study Grp
目的1型糖尿病儿童进展为3期（临床）糖尿病的风险很高，需要准确的监测。我们的目标是建立动态血糖监测（CGM）指标，可以预测即将进展为糖尿病。研究设计和方法在儿童自身免疫筛查研究中，91名基线CGM持续胰岛自身抗体阳性的儿童（中位年龄11.5岁; 48%为非西班牙裔白色; 57%为女性）被随访糖尿病发展，中位时间为6个月（范围0.2-34）。其中，16例（18%）在中位4.5（范围0.4-29）个月内进展为临床糖尿病。结果与未进展为临床糖尿病的儿童相比，（不进步者），（进展者）的平均探头葡萄糖水平显著更高（119 vs. 105 mg/dL，P < 0.001）和血糖变异性增加（SD 27 vs. 16，变异系数21 vs. 15，每日差异平均值24 vs. 16，血糖波动平均幅度43 vs. 26，所有P < 0.001）。对于进展者，21%的时间花费在葡萄糖水平> 140 mg/dL（TA 140）和8%的时间> 160 mg/dL，而非进展者分别为3%和1%。在生存分析中，TA 140> 10%的患者在1年内进展为糖尿病的风险为80%;相比之下，其他参与者仅为5%。通过受试者工作曲线分析的预测性能显示，对于单独和组合CGM度量模型，曲线下面积>= 0.89。结论：在自身抗体阳性儿童中，TA 140> 10%与未来一年内进展为临床糖尿病的高风险相关。CGM应纳入高危儿童的持续监测，并可作为预防试验的潜在入选标准。
OBJECTIVE Children identified with stage 1 type 1 diabetes are at high risk for progressing to stage 3 (clinical) diabetes and require accurate monitoring. Our aim was to establish continuous glucose monitoring (CGM) metrics that could predict imminent progression to diabetes. RESEARCH DESIGN AND METHODS In the Autoimmunity Screening for Kids study, 91 children who were persistently islet autoantibody positive (median age 11.5 years; 48% non-Hispanic White; 57% female) with a baseline CGM were followed for development of diabetes for a median of 6 (range 0.2-34) months. Of these, 16 (18%) progressed to clinical diabetes in a median of 4.5 (range 0.4-29) months. RESULTS Compared with children who did not progress to clinical diabetes (nonprogressors), those who did (progressors) had significantly higher average sensor glucose levels (119 vs. 105 mg/dL, P < 0.001) and increased glycemic variability (SD 27 vs. 16, coefficient of variation, 21 vs. 15, mean of daily differences 24 vs. 16, and mean amplitude of glycemic excursions 43 vs. 26, all P < 0.001). For progressors, 21% of the time was spent with glucose levels > 140 mg/dL (TA140) and 8% of time > 160 mg/dL, compared with 3% and 1%, respectively, for nonprogressors. In survival analyses, the risk of progression to diabetes in 1 year was 80% in those with TA140 > 10%; in contrast, it was only 5% in the other participants. Performance of prediction by receiver operating curve analyses showed area under the curve of >= 0.89 for both individual and combined CGM metric models. CONCLUSIONS TA140 > 10% is associated with a high risk of progression to clinical diabetes within the next year in autoantibody-positive children. CGM should be included in the ongoing monitoring of high-risk children and could be used as potential entry criterion for prevention trials.