Daily glucose profile (DGP) involves various factors contributing to diabetic complications: diet, physical activity, insulin dose, social context and stressors. We aimed to identify specific DGPs susceptive to microvascular complication in T1D, exploring endpoint-oriented CGM metrics.
First, cluster analysis with 5,584 pooled DGPs from 102 T1D subjects detected 4 major clusters characterized as aligned control (A), biphasic dysglycemia (B), continuous nocturnal hyperglycemia (C) and dyscontrol (D) (Figure 1). The presence of neuropathy and nephropathy was significantly associated with the increase of cluster B (+76%, p=0.002) and C (+69%, p=0.002), respectively.
Next, we determined metric ∫B/∫C as the integration of loge (glucose excursions from 70-180 mg/dL):0-12am/:0-6am to represent cluster B/C. To evaluate ∫B/∫C, the retrospective study investigated 18,457 DGPs from 231 adults with T1D (steroid users and available DGPs <10 days were excluded; age 21-78, female 68%, A1c 5.5-12%). The higher ∫B/∫C (Q4) were independent risk factors for retinopathy (OR=3.18), neuropathy (OR=4.69) and the increase of albuminuria (t=2.11) after adjustment for age, gender, duration, smoking, BMI, A1c, HT, HL and T. bilirubin.
New CGM metrics ∫B/∫C derived from vulnerable DGP clusters may support risk assessment and early intervention for diabetic complications.
Y. Maeda: Research Support; Self; Abbott, Arkray, Inc. Speaker's Bureau; Self; Abbott, Arkray, Inc., Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kissei Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Terumo Medical Corporation. M. Morita: None. A. Tamura: None. K. Takasu: None. Y. Kurogi: None. I. Nimura: Speaker's Bureau; Self; Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Taisho Pharmaceutical Co., Ltd. R. Yoshioka: None. M. Minami: Speaker's Bureau; Self; Abbott, Eli Lilly and Company, Medtronic, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi, Terumo Medical Corporation.
Kondou Kinen Medical Foundation