Endocrine Abstracts

Introduction: Glycated hemoglobin has long been considered the gold standard for monitoring diabetic patients. however, the advent of CGM, revolutionized the monitoring of diabetics with the possibility of detecting glycemic variability in patients.

Method: This is a descriptive cross-sectional study conducted at the National Institute of Nutrition in Tunis. Adolescents with type 1 diabetes were recruited and they wore a CGM device for 7 days. A1C and clinical information were collected. We analyzed the CGM data for each patient and we calculated the coefficient of variability of glucose (CV), mean of glycemic excursions (MAGE) and the mean of daily differences (MODD).

Results: We included 81 patients with type 1 diabetes in our study, with an average age of 16±2 years old. A female predominance was noted (58%). The mean duration of diabetes was 6± 4 years. A1C ranged from 5.7% to 14%, with a mean of 9.8 ±1.8%. The average of CV, MAGE and MODD was: 39.8±12%; 141±45 mg/dl; and 81±41 mg/dl respectively. Participants were stratified by high CV (>36%; n=48) and low CV (≤36%; n=33). A statistically significant difference was objectified in A1C levels between the groups In fact, patients in group low CV had higher A1C levels (10.3 ±1.7%) than those in group high CV (9.4 ±1.9%) with(P=0.042). The high CV group spent more time in hypoglycemia compared with the group low CV (The average of Time Below Range (TBR) was 10.6±11% vs 1.5±2.5%) with P=0.000. The time spent in nocturnal hypoglycemia (calculated by CGM) was significantly higher in patients with high CV (15,7±12% vs 3.6±8.8%; P=0,000)

Conclusion: In our study, we found that A1C levels were higher in the low CV group, this underlines the fact that patients with target A1C levels may have high glycemic variability. The CV can better identify individuals at high risk of hypoglycemia compared with A1C alone. To conclude that glycemic variability metrics should be combined with A1C for better diabetes management in people with type 1 diabetes.