ABSTRACT
Background: To analyze key indicators of metabolic control in adults with type 1 diabetes (T1D) using real-time or intermittent scanning continuous glucose monitoring (rtCGM/iscCGM) during real-life care, based on the German/Austrian/Swiss Prospective Diabetes Follow-up (DPV) registry. Methods: Cross-sectional analysis including 233 adults with T1D using CGM. We assessed CGM metrics by gender, age group (18 to <30 years vs. ≥30 years), insulin delivery method (multiple daily injections vs. continuous subcutaneous insulin infusion [CSII]) and sensor type (iscCGM vs. rtCGM), working days versus weekends, and daytime versus night-time using multivariable linear regression models (adjusted for demographic variables) or Wilcoxon signed-rank test. Results: Overall, 79/21% of T1D patients used iscCGM/rtCGM. Those aged ≥30 years spent more time in range (TIR [70-180 mg/dL] 54% vs. 49%) and hypoglycemic range <70 mg/dL (7% vs. 5%), less time in hyperglycemic range >180 mg/dL (38% vs. 46%) and had a lower glucose variability (coefficient of variation [CV] 36% vs. 37%) compared with adults aged <30 years. We found no significant differences between genders. Multivariable regression models revealed the highest Time In Range (TIR) and lowest time with sensor glucose >250 mg/dL, CV and daytime-night-time differences in those treated with CSII and rtCGM. Glucose profiles were slightly more favorable on working days. Conclusions: In our real-world data, rtCGM versus iscCGM was associated with a higher percentage of TIR and improved metabolic stability. Differences in ambulatory glucose profiles on working and weekend days may indicate lifestyle habits affecting glycemic stability. Real-life CGM results should be included in benchmarking reports in addition to hemoglobin A1c (HbA1c) and history of hypoglycemia.
Subject(s)
Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 1 , Insulin/administration & dosage , Adolescent , Adult , Austria , Blood Glucose , Cross-Sectional Studies , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/drug therapy , Female , Follow-Up Studies , Germany , Glycated Hemoglobin/analysis , Humans , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Male , Prospective Studies , Registries , Switzerland , Young AdultABSTRACT
AIMS: To investigate risk factors for declining renal function among subjects with type-1-diabetes. METHODS: Observational study based on data from the diabetes registry DPV. 4424 type-1-diabetes subjects aged ≥18â¯years, age at onset <18â¯years were identified. Modification of Diet in Renal Disease (MDRD) equation was used to estimate glomerular filtration rate (eGFR). Annual rate of renal decline was estimated for each patient using hierarchic linear regression models. Additional regression models were fitted to adjust for covariates. RESULTS: Median age was 26 [Q1; Q3: 21; 39]â¯years. Annual decline of renal function was -1.22 (95% CI: -1.50; -0.94)â¯ml/min/1.73â¯m2. At baseline, higher eGFR was related to more rapid decline compared to impaired or reduced eGFR (GFRâ¯≥â¯90: -2.06 (-2.35; -1.76), 60â¯≤â¯GFRâ¯<â¯90: 0.45 (0.08; 0.81), GFRâ¯<â¯60: 0.52 (-0.24; 1.29)â¯ml/min/1.73â¯m2, pâ¯<â¯0.01). During follow-up, the highest decline was associated with reduced renal function, whereas the lowest decline was related to normal kidney function (pâ¯<â¯0.01). Poor metabolic control (pâ¯=â¯0.04), hypertension (pâ¯<â¯0.01) and albuminuria (pâ¯=â¯0.03) were associated with more rapid loss of kidney function. No difference was observed among insulin regimen. CONCLUSION: Among this large type-1-diabetes cohort, more rapid loss of kidney function was related to higher baseline eGFR, log-term worse metabolic control and diabetic comorbidities.
