ESPE Abstracts

Introduction: Glycated hemoglobin (HbA1c) is a rough indicator of glycemic control and not useful to evaluate aspects related to acute or daily glycemic changes in diabetic patients. With the emphasis on intensive management of type 1 diabetes (T1DM), data from studies support using Continuous Glucose Monitoring (CGM) to improve glycemic control and reduce glucose variability, which is related to an increase in macro and microvascular complications.

Aim of the study: To find the relation, if any, between the CGM data of children with T1DM and glycemic control assessed by measuring HbA1c.

Patients and Method: We studied 20 patients (age 5-14 years) with T1DM using Flash monitoring CGM(FiCGM). The time in range (TIR) glucose (70-180mg/dl), time above range (TAR) glucose >180mg/dl, time below range (TBR) glucose <70mg/glucose variability (GV) and glucose management indicator (GMI) were recorded for 7 days) over 2 outpatient clinic visits at 6 months and 12 months post diagnosis. The estimated and measured HbA1C levels were recorded and compared with the CGM data.

Results: In our children with T1DM, the mean HbA1C after 6 and 12 months = 7 +/-1.24 % and 7.4 +/- 1.27% respectively. Growth parameters were normal (table 1). Highly significant negative correlations were detected between measured HbA1C and TIR (r= -0.89, P < 0.001), and measured HbA1c and GMI (r= -0.898, P < 0.001). A significant positive correlation was detected between HbA1C and TAR (r= 0.895, P < 0.001) and between the estimated and measured HbA1c. Glucose variability (GV) was correlated significantly with TBR (r= 0.45, p =0.003)

Conclusion: CGM is a good tool for day-to-day monitoring and accurately guiding management of diabetes in timely basis. Increasing the TIR and decreasing the TAR significantly improve long term glycemic control. However, tightening glycemic control (by increasing time below range (TBR) can increase glucose variability and compromise glycemic control. Diabetes control aims in A strategy for keeping glucose level in range while simultaneously avoiding hypoglycemia can optimize glycemic control.