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Glucose control and variability assessed by continuous glucose monitoring in patients with type 1 diabetes and diabetic kidney disease

Aleksejs Fedulovs,Jana Janeviča,Lelde Krūzmane,J. Sokolovska

Published 2024 in Biomedical Reports

ABSTRACT

Continuous glucose monitoring (CGM) has emerged as a superior method to glycated hemoglobin (HbA1c) monitoring for glycemic control assessment in type 1 diabetes (T1D). The association between CGM parameters and diabetic kidney disease (DKD) has not been extensively researched. The aim of the present study was to compare CGM metrics between patients with stable and progressive DKD and T1D. A cross-sectional study was performed with 75 patients with T1D, of which 28 had progressive DKD, defined as an estimated glomerular filtration rate decrease of ≥3 ml/min/year or an increased albuminuria stage over the median follow-up time of 7.46 (6.50-8.16) years. FreeStyle Libre ProiQ Sensors were used for CGM. Insulin sensitivity was calculated according to the estimated glucose disposal rate (eGDR) formula. The results revealed that as compared with subjects with stable DKD, individuals with progressive DKD exhibited a higher average glucose level (P=0.03), spent more time above the target range (P=0.05), less time in time in range (TIR; P=0.03), had a higher median estimated HbA1c (P=0.02) and glucose management indicator (P=0.03), as well as a longer duration of hypoglycemic events (P=0.03). There were no differences in compliance levels and recognition of hypoglycemia between the DKD study groups. Differences in correlation patterns between CGM parameters in patients with stable and progressive DKD were observed. For example, glucose variability was significantly positively correlated with TIR in subjects with DKD (Ρ=0.390; P=0.04) but not in individuals without DKD. The progression of DKD was statistically significantly associated with several CGM parameters in multivariate logistic regression models. Collectively, associations between CGM metrics and DKD status were demonstrated in patients with T1D. The findings of the present study indicate the necessity for regular CGM in patients with progressive DKD for improvement of their glycemic control and DKD outcomes but also call for the development of a personalized approach to CGM data interpretation and establishing therapeutic targets in these subjects.

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