CGM Metrics Identify Dysglycemic States in Participants From the TrialNet Pathway to Prevention Study

Abstract

OBJECTIVE Continuous glucose monitoring (CGM) parameters may identify individuals at risk for progression to overt type 1 diabetes. We aimed to determine whether CGM metrics provide additional insights into progression to clinical stage 3 type 1 diabetes. RESEARCH DESIGN AND METHODS One hundred five relatives of individuals in type 1 diabetes probands (median age 16.8 years; 89% non-Hispanic White; 43.8% female) from the TrialNet Pathway to Prevention study underwent 7-day CGM assessments and oral glucose tolerance tests (OGTTs) at 6-month intervals. The baseline data are reported here. Three groups were evaluated: individuals with 1) stage 2 type 1 diabetes (n = 42) with ≥2 diabetes-related autoantibodies and abnormal OGTT; 2) stage 1 type 1 diabetes (n = 53) with ≥2 diabetes-related autoantibodies and normal OGTT; and 3) negative test for all diabetes-related autoantibodies and normal OGTT (n = 10). RESULTS Multiple CGM metrics were associated with progression to stage 3 type 1 diabetes. Specifically, spending ≥5% time with glucose levels ≥140 mg/dL (P = 0.01), ≥8% time with glucose levels ≥140 mg/dL (P = 0.02), ≥5% time with glucose levels ≥160 mg/dL (P = 0.0001), and ≥8% time with glucose levels ≥160 mg/dL (P = 0.02) were all associated with progression to stage 3 disease. Stage 2 participants and those who progressed to stage 3 also exhibited higher mean daytime glucose values; spent more time with glucose values over 120, 140, and 160 mg/dL; and had greater variability. CONCLUSIONS CGM could aid in the identification of individuals, including those with a normal OGTT, who are likely to rapidly progress to stage 3 type 1 diabetes.

Predicting the Risk of Developing Type 1 Diabetes Using a One-Week Continuous Glucose Monitoring Home Test With Classification Enhanced by Machine Learning: An Exploratory Study

“…19 Helminen et al 16 reported that children in the autoantibody-positive group had higher percent time with CGM readings ≥140 mg/dL (5.8% vs 0.4%) and mean seven-day sensor glucose (97.2 mg/dL vs 84.6 mg/dL). Wilson et al 20 reported that spending ≥5% or 8% time with glucose levels ≥140 or 160 mg/dL, is associated with progression to stage 3 T1D. This study also found that stage 2 participants and those who progressed to stage 3 exhibited higher mean daytime glucose values, spent more time with Figure 3.…”

“…The use of the percent time spent with CGM readings >140 mg/dL has been proposed by other studies assessing those at risk for T1D. Wilson et al, 20 investigated a one-week CGM test for its ability to identify individuals at higher risk for rapid progression to stage 3 T1D, including those with a normal OGTT. This study has identified several CGM-derived metrics of hyperglycemia associated with progression to stage 3 disease.…”

Exploring interpretable representations for heart sound abnormality detection

“…There have also been prior works that seek to predict post-prandial glycemic responses (Ben-Yacov et al, 2021), characterize diabetes disease progres-sion (Wilson et al, 2023), and subtype glycemic control (Keshet et al, 2023). However, these works rely solely on expert hand-crafted features, which are lower quality than our learned embeddings, as demonstrated in Table 2.…”

Beta cell function in the early stages of type 1 diabetes: still a long way ahead of us

“…A percentage of time with sensor glucose ≥ 140 mg/dl ≥ 5% or ≥ 8% resulted in 80% specificity and 48% sensitivity and 90% specificity with 38% sensitivity, respectively, to predict progression to Stage 3 T1D. A higher glucose threshold (≥ 160 mg/dl) resulted in a lower sensitivity (28% and 14%, respectively) [ 26 ]. These findings suggest that CGM might be a complimentary tool for screening those at risk for progression.…”