Abstract
Children with type 1 diabetes (T1DM) are the high-risk group of accelerated atherosclerosis. Real-time continuous glucose monitoring (RT-CGM) provides possibilities for the detection of glycaemic variability, newly recognized cardiovascular risk factor. The aim of the study was to assess the usefulness of RT-CGM as an educational tool to find and reduce glycaemic variability in order to improve endothelial function in T1DM adolescents. Forty patients aged 14.6 years were recruited. The study was based on one-month CGM sensors use. Parameters of glycaemic variability were analyzed during first and last sensor use, together with brachial artery flow-mediated dilatation (FMD) to assess endothelial function. In the whole group, FMD improvement was found (10.9% to 16.6%, p < 0.005), together with decrease in all studied glycaemic variability parameters. In patients with HbA1c improvement compared to the group without HbA1c improvement, we found greater increase of FMD (12% to 19%, p < 0.005 versus 8.2% to 11.3%, p = 0.080) and greater improvement of glucose variability. RT-CGM can be considered as an additional tool that offers T1DM adolescents the quick reaction to decrease glycaemic variability in short time observation. Whether such approach might influence improvement in endothelial function and reduction of the risk of future cardiovascular disease remains to be elucidated.
Highlights
Type 1 diabetes mellitus (T1DM) is a well-established risk factor of accelerated cardiovascular disease, and, on the other hand, cardiovascular disease is the major cause of mortality in this group of patients
The glucose variability parameters were better at the beginning of the study and at the end as well in the group with initial optimal glycaemic control when compared appropriately with first and last sensor use in poor control group (Table 3)
As we have subdivided our patients into two groups depending on the initial HbA1c level (>7.5% and
Summary
Type 1 diabetes mellitus (T1DM) is a well-established risk factor of accelerated cardiovascular disease, and, on the other hand, cardiovascular disease is the major cause of mortality in this group of patients. Blood glucose instability may contribute, perhaps even more than elevated HbA1c, to the development of diabetes complications [3, 4]. These extreme glucose fluctuations lead to endothelial dysfunction and accelerated atherosclerosis, independently of average glucose concentrations, probably in mechanism of oxidative stress occurrence [5, 6]. T1DM in childhood is recognized as a high-risk factor for premature atherosclerosis [8,9,10]
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