SFEIES24 Oral Communications Oral Communications (10 abstracts)
The relation of microvascular complications to a new interpretation of glycaemic variability from continuous glucose monitoring in people with type 1 diabetes (T1D)
Adrian Heald 1 , Mike Stedman 2 , Angela Paisley 1 , John Warner Levy 3 , Lleyton Belston 3 , Martin Gibson 1 , Martin Whyte 4 , Hellena Habte-Asres 4 & Angus Forbes 4
1Saflord Royal Hospital, Salford, United Kingdom; 2Res Consortium, Andover, United Kingdom; 3University of Manchester, Manchester, United Kingdom; 4Kings College Hospital, London, United Kingdom
Introduction: Microvascular and macrovascular complications in type 1 diabetes T1D) may be linked to endothelial stress due to glycaemic variability. This work aimed to examine whether determination of glycaemic parameters including glucose variability (GV) over an 18month period is associated with microvascular clinical sequelae.
Methods: Freestyle Libre 15-minute glucose values were downloaded for 89 T1DM individuals for up to 18 months from 2021 to 2023 and were analysed via three novel glucose management indices: glucose management indicator (GMI), average glucose fluctuation (AGF), time spent above a high blood glucose threshold. Our measured clinical outcomes included glomerular filtration rate (eGFR), average annual change in eGFR following a previous reading at least 4 years previously, and current retinal screening status.
Results: Results for 89 individuals (44 men/45 women) were analysed over 18 months. Mean age was 43years and the mean duration of diabetes was 18years. A total of 3.22 million readings were analysed, giving an average of 10.3 mmol/l blood glucose. Those with the largest change in glucose from reading, to reading summated over time (18months) showed the greatest change in eGFR of 3.12ml/min/1.73m2 (P = 0.007). People with a higher proportion of glucose readings >18mmol/l showed a fall in eGFR of 2.8 ml/min/1.73 m2 (P = 0.009) and experienced higher rates of sight threatening retinopathy (44% of these individuals) (P = 0.01) as did 39% of individuals in the highest tertile of glucose levels. (P = 0.008).
Conclusion: Those T1D individuals in the highest tertile of reading-to-reading glucose change, showed greatest change in eGFR. Those with a higher proportion of glucose readings >18mmol/l also showed a fall in eGFR and experienced higher rates of retinopathy as did people with higher mean glucose. Discussions with T1D individuals could reflect on how % recorded glucose above a critical level and degree of change in glucose are important in avoiding tissue complications.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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