Mean Glycemia Research Articles

De-Intensification from Basal-Bolus Insulin Therapy to Liraglutide in Type 2 Diabetes: Predictive Value of Mean Glycaemia during Fasting Test.

Successful conversion from insulin therapy to glucagon-like peptide 1 receptor agonist (GLP-1RA) with basal insulin in well-controlled patients has already been demonstrated. However, the data concerning individuals with poor glycaemic control are scarce. The aim of this work was to assess the success rate of insulin therapy to liraglutide transition in poorly controlled diabetes in a real-world clinical setting and to define predictors of success. We are the first to present the method of a fasting test as a way to identify the patients at higher risk of failure after treatment de-intensification. The retrospective observational study analyzed data of 62 poorly controlled obese diabetic patients on high-dose insulin therapy, who were subjected to a 72 h fasting test during hospitalization and subsequently switched to liraglutide ± basal insulin therapy. During the fasting, all antidiabetic treatment was discontinued. Patients were classified as responders if they remained on GLP-1RA treatment after 12 months. Non-responders restarted the basal-bolus insulin (BBI) regimen. Development of glycated hemoglobin (HbA1c) and body weight in both groups, alongside with parameters associated with the higher risk of return to the BBI regimen, were analyzed. A total of 71% of patients were switched successfully (=responders). Responders had more significant improvement in HbA1c (-6.4 ± 19.7 vs. -3.4 ± 22.9 mmol/mol) and weight loss (-4.6 ± 7.1 vs. -2.5 ± 4.0). Statistically significant difference between groups was found in initial HbA1c (75.6 ± 17.9 vs. 90.5 ± 23.6; p = 0.04), total daily dose of insulin (67.6 ± 36.4 vs. 90.8 ± 32.4; p = 0.02), and mean glycaemia during the fasting test (6.9 ± 1.7 vs. 8.6 ± 2.2 mmol/L; p < 0.01). This study confirms that therapy de-intensification in poorly controlled patients with a BBI regimen is possible. Higher baseline HbA1c, total daily insulin dose, and mean glucose during fasting test are negative predictive factors of successful therapy de-escalation.

Advanced Glycation Endproducts: A Marker of Long-term Exposure to Glycemia.

This article examines the importance of advanced glycation endproducts (AGEs) and summarizes the structure of AGEs, pathological changes associated with AGEs, the contribution of AGEs to metabolic memory, and the value of AGEs as a predictor of diabetic complications and cardiovascular disease in people with and without diabetes. As a practical focus, skin autofluorescence (SAF) is examined as an attractive approach for estimating AGE burden. The measurement of AGEs may be of significant value to specific individuals and groups, including Black and Hispanic/Latino Americans, as they appear to have higher concentrations of hemoglobin A1c (HbA1c) than would be predicted by other metrics of mean glycemia. We hypothesize that if the amount of glycation of HbA1c is greater than expected from measured glucose levels, and if AGEs are accumulating, then this accumulation of AGEs might account for the increased rate of complications of diabetes in populations with high rates of vascular disease and other complications. Thus, identifying and modifying the burden of AGEs based on measurement of AGEs by SAF may turn out to be a worthwhile metric to determine individuals who are at high risk for the complications of diabetes as well as others without diabetes at risk of vascular disease. We conclude that available evidence supports SAF as both a clinical measurement and as a means of evaluating interventions aimed at reducing the risks of vascular disease and diabetic complications.

Glycemic variability in diagnosis of gestational diabetes as predictor of pharmacological treatment

IntroductionTo establish whether glycemic variability (GV) parameters used when gestational diabetes mellitus (GDM) has been diagnosed could help predict the probability that a patient will need pharmacological treatment, and to analyze the link of these parameters to the development of maternal-fetal complications. Materials and methodsA prospective study of 87 women with GDM who underwent retrospective continuous glucose monitoring (CGM) for six days between weeks 26 and 32 of gestation, following diagnosis. The mean glycemia levels and GV variables were analyzed together with their link to maternal-fetal complications, and the need for pharmacological treatment. ROC (receiver operating characteristic) curves were developed to determine validity to detect the need for pharmacological treatment. ResultsPatients with higher mean glycemia (p < 0.001) and continuous overlapping of net glycemic action in a period of n-hours (CONGAn) (p = 0.001) required pharmacological treatment. The ROC curves showed cut-off points of 98.81 mg/dL for mean glycemia, and 86.70 mg/dL for CONGAn, with 83.3% sensitivity and 67.8% specificity for both parameters. No relation between the GV parameters and development of maternal-fetal complications was observed. ConclusionsThe use of CGM, once GDM is diagnosed, enables us to identify those patients who would benefit from closer monitoring during gestation, and facilitate a speedier take-up of pharmacological treatment. However, prospective studies involving a higher number of patients are needed, as well as a cost assessment for recommending the use of CGM following GDM diagnosis.

Estimating Glycemia From HbA1c and CGM: Analysis of Accuracy and Sources of Discrepancy.

To examine the accuracy of different periods of continuous glucose monitoring (CGM), hemoglobin A1c (HbA1c), and their combination for estimating mean glycemia over 90 days (AG90). We retrospectively studied 985 CGM periods of 90 days with <10% missing data from 315 adults (86% of whom had type 1 diabetes) with paired HbA1c measurements. The impact of mean red blood cell age as a proxy for nonglycemic effects on HbA1c was estimated using published theoretical models and in comparison with empirical data. Given the lack of a gold standard measurement for AG90, we applied correction methods to generate a reference (eAG90) that we used to assess accuracy for HbA1c and CGM. Using 14 days of CGM at the end of the 90-day period resulted in a mean absolute error (95th percentile) of 14 (34) mg/dL when compared with eAG90. Nonglycemic effects on HbA1c led to a mean absolute error for average glucose calculated from HbA1c of 12 (29) mg/dL. Combining 14 days of CGM with HbA1c reduced the error to 10 (26) mg/dL. Mismatches between CGM and HbA1c >40 mg/dL occurred more than 5% of the time. The accuracy of estimates of eAG90 from limited periods of CGM can be improved by averaging with an HbA1c-based estimate or extending the monitoring period beyond ∼26 days. Large mismatches between eAG90 estimated from CGM and HbA1c are not unusual and may persist due to stable nonglycemic factors.

Glucose Metabolism and Cognitive Decline in Progressive Supranuclear Palsy and Corticobasal Syndrome: A Preliminary Study.

Multiple studies have analyzed the possible correlations between diabetes and Alzheimer's disease. Less is known about the context of cognitive deterioration among patients with atypical Parkinsonian syndromes and glucose metabolism impairment. The aim of this study was to evaluate the association between the impaired glucose metabolism and cognitive decline among patients with progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). The study included 22 patients with PSP and CBS with disease durations varying from 3 to 6 years. The levels of glycated hemoglobin (HbA1C), fasting blood glucose, fasting C-peptide and the presence of microalbuminuria were evaluated, and oral glucose tolerance tests (OGTT) were performed. Based on the OGTT results, the glycemic variability, mean glycemia, glycemia standard deviation (SD) and coefficient of variation (%CV) were calculated. All patients underwent a three-Tesla brain magnetic resonance (MRI) examination and neuropsychological cognitive assessment with the use of standardized scales: Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). A statistical analysis revealed that poor control of glycemia with high glycemic variability and increased atrophy of the medial temporal lobe among patients with PSP and CBS correlated with worse cognitive performance independent of age or sex, even among patients who did not fulfill the criteria for diabetes. The study results indicate the importance of glucose metabolism control and optimal treatment in the context of cognition maintenance among patients with PSP and CBS. Due to the relatively small number of analyzed patients, the issue requires further assessment. To the best of our knowledge, this is the first study discussing the role of glycemic variability in atypical Parkinsonian syndromes.

Differential Spectrum of Albumin Glycation, Oxidation, and Truncation in Type 2 and Type 1 Diabetes: Clinical and Biological Implications.

Background: Albumin, the most abundant and physiologically vital serum protein, accumulates a range of chemical modifications, as consequence of encounters with large number of reactive molecules whose concentrations increase in serum under pathological conditions. Methods: In a "proof of concept" study, mass spectrometric analysis was utilized to quantitate albumin post-translational modifications (glycation, oxidation, and truncation; individual isoforms and total) in four informative subject groups [type 1 diabetes (T1DM), type 2 diabetes (T2DM), prediabetes-obesity and healthy; all with estimated glomerular filtration rate ≥60 mL/(min·m2)]. Besides glycated albumin (GA/mass spectrometry), glycated serum protein (GSP/nitro blue tetrazolium colorimetry), and glycated hemoglobin (HbA1c/high-performance liquid chromatography) were also measured. Results: A wide spectrum of albumin molecular modifications was identified in diabetes, with significant differences between T2DM and T1DM. Albumin glycation: GA correlated more strongly with HbA1c in T1DM, compared to T2DM. Higher albumin glycation isoforms (human serum albumin +3G/2G) were more stable and discriminative markers of mean glycemia. Albumin oxidation: T2DM, in comparison with T1DM, showed enhanced oxidative and dual (glycation plus oxidation) modifications, representing extreme molecular pathology. Albumin truncation: There was dramatic reduction ("deficiency") of truncated albumin isoforms in T2DM, and significant reduction in T1DM. Albumin truncation negatively correlated with severity of albumin glycation (mean glycemia) and albumin oxidation (cysteinylation). Possible mechanisms of insulin resistance, with associated increased free fatty acids binding to albumin, in stimulating albumin oxidation and inhibiting albumin glycation ("metabolic cross talks") are reviewed. Conclusions: Albumin molecular modifications in diabetes, together with significant differences between T2DM and T1DM, suggest possible role for insulin resistance in their genesis and consequent cell, tissue, and vascular dysfunction/damage. Albumin molecular fingerprinting can provide valuable insights into pathogenesis, diagnosis, monitoring, and future therapies for diabetes. Identification of biomarker battery ("albuminomics," "diabetomics") driven diverse "healthy," prediabetes, obesity, and T2DM phenotypes represents additional novel step toward precision medicine in diabetes and related disorders.

Indices of glycemic variability as the basis for building a prognostic model for the development of diabetic complications

The use of mathematical indices of glycemic variability (IGV) opens up new possibilities in predicting diabetic complications, which allows more accurate correction of therapy and prevention of the development of acute and chronic conditions. Aim. To analyze the predictive capabilities of glycemic variability indices to assess the development and progression of diabetic complications Material and methods. The study included 307 patients with type 1 diabetes mellitus (DM1). In all patients, glycated hemoglobin (HbA1c) was assessed, as well as the main indicators of glycemic control and IGV, which were selected to predict the formation and progression of diabetic complications. Statistical analysis was carried out using the SPSS 23.0 program. To build a model for predicting diabetic complications, the logistic regression method was used. Results. During the work, there was a decrease in HbA1c from 9.0 to 8.0% (p 0.005), as well as a change in the main parameters of carbohydrate metabolism and IGV. A predictive model for diabetic complications was built on the basis of HbA1c, mean glycemia and IGV – SD, CONGA, LI, LBGI, HBGI, MODD, MAGE, ADDR, MAG at the first study visit. The predictive model for the development of diabetic complications was considered significant at p 0.05. The resulting model showed a high sensitivity – 92% and a sufficient specificity of 85%. Not all parameters turned out to be statistically significant, however, with the exclusion of some, the sensitivity and specificity of the model decrease, which indicates the importance of each of the IGVs in predicting diabetic complications. Concludion. By analyzing the IGV, and not just the standard methods for assessing carbohydrate metabolism, the doctor can more accurately judge the compensation for diabetes and give the patient individual recommendations for treatment. Evaluation of GV, in particular its mathematical indices, play a significant role in predicting the development and progression of diabetic complications in patients with DM1 in childhood and adolescence.

A comparative study using insulin pump therapy and continuous glucose monitoring in newly diagnosed very young children with type 1 diabetes: it is possible to bend the curve of HbA1c.

The target of metabolic control (HbA1c < 7% or 53mmol/mol) recommended by the ADA and ISPAD is attained by 30% of children with Type 1 Diabetes (T1D). Advances in technologies for T1D aim to improve metabolic outcomes and reduce complications. This observational study assesses the long-term outcomes of advanced technologies for treatment of T1D compared to conventional approach started at onset in a group of very young children with T1D. 54 patients with less 4years old at onset of T1D were enrolled and followed for up to 9years after diagnosis. 24 subjects started continuous subcutaneous insulin (CSII) treatment and 30 subjects received MDI therapy from onset. Auxological data, HbA1c and total daily insulin dose (TDD/kg) have been collected at admission and every 4months. HbA1cAUC>6%, rates of acute complications, glycemic variability indices and glucometrics were also recorded. Patients with CSII therapy had significantly lower mean HbA1c values compared to subjects receiving MDI treatment. CSII approach also recorded lower mean HbA1cAUC>6% and TDD/kg than MDI therapy. At the last download data, the time in range (TIR) was higher in patients with CSII and hyperglycemia events were lower. Better glycemic variability indices have been described during CSII therapy, including mean glycemia, standard deviation, coefficient of variation (CV), glycemia risk index (GRI) and high blood glucose index (HBGI). There was no statistically significant difference between frequency of severe hypoglycemia and ketoacidosis episodes between groups. Early initiation of diabetes technologies is safe and able to determine a better long term glycemic control in young children with T1D. It also allows to flatten the trajectory of HbA1c, probably reducing microvascular, macrovascular and neurological complications of diabetes in this very peculiar age group.

Glycemia Risk Index as a novel metric to evaluate the safety of glycemic control in children and adolescents with Type 1 Diabetes: an observational, multicenter, real-life cohort study.

Glycemia Risk Index (GRI) is a novel composite metric for the evaluation of the safety of glycemic management and control. The aim of this study was to evaluate GRI and its correlations with continuous glucose monitoring (CGM) metrics by analysing real-life CGM data in 1067 children/adolescents with type 1 Diabetes (T1D) using four different treatment strategies (intermittently scanned CGM [isCGM]-Multiple daily injections [MDI]; real time CGM [rtCGM]-MDI; rt-CGM-insulin pump [IP]; Hybrid Closed-Loop [HCL] therapy). GRI was positively correlated with High Blood Glucose Index (HBGI), Low Blood Glucose Index (LBGI), mean glycemia, its standard deviation, coefficient of variation and HbA1c. The four treatment strategies groups showed significantly different GRI with the lowest value in the HCL group (30.8) and the highest in the isCGM-MDI group (68.4). These findings support the use of GRI for the assessment of the glycemic risk and the safety of specific treatment in paediatric subjects with T1D.

Flash glucose monitoring in gestational diabetes mellitus (FLAMINGO): a randomised controlled trial

AimsGestational diabetes mellitus (GDM) is the most common type of hyperglycaemia in pregnancy. GDM is a risk factor of adverse perinatal outcomes, with the incidence rate increasing proportionally to the level of maternal dysglycaemia. Therefore, glycaemic control plays an important role in management of GDM. The aim of this study was to assess the efficacy of flash glucose monitoring (FGM) in GDM.Materials and methodsThis was a non-blinded, randomised controlled trial, that recruited 100 pregnant women diagnosed with GDM between 24 and 28 weeks of gestation at the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw. After meeting the inclusion criteria patients were randomly allocated to the study group (FGM, n = 50) or control group (self-monitoring of blood glucose—SMBG, n = 50). Clinical and laboratory results were assessed at four follow-up visits. The primary outcome was mean fasting and postprandial glycaemia. The secondary outcomes were perinatal outcomes.ResultsThere was no significant difference in mean glycaemia between the groups (p = 0.437) Compared to the control group, the study group significantly reduced their fasting (p = 0.027) and postprandial glycaemia (p = 0.034) during the first 4 weeks following GDM diagnosis, with no significant difference in progression to insulin therapy (OR 1.09, 95% CI 0.47–2.57). Incidence of fetal macrosomia was significantly higher in SMBG as compared to FGM group (OR 5.63, 95% CI 1.16–27.22). ConclusionsStudy results indicate that FGM has an impact on glycaemic control, dietary habits and incidence of fetal macrosomia in patients with GDM.Trial registration clinicaltrials.gov ID: NCT04422821.

Glycaemic profile of children undergoing anaesthesia (GLYCANA) at Mercy James Centre in Malawi: an observational study

BackgroundHypoglycaemia and hyperglycaemia may develop during anaesthesia and surgery in children and can lead to severe adverse clinical outcomes. No study, as far as we know, has investigated glucose homeostasis in children undergoing surgery in Malawi. The aim of this study was to assess perioperative glucose levels of the children undergoing anaesthesia at Mercy James Centre (MJC) for Paediatric Surgery, Blantyre, Malawi.MethodologyThis was an observational cross-sectional study. We looked at 100 children aged 1 day to 15 years anaesthetised at MJC. Data were analysed using SPSS 28. Student t test and Analysis of the variance (ANOVA) were used to compare means. The level of significance was 5%.ResultsMale children represented 68%. The median age was 2.2 years. Sixten percents of patient were underweight. Fasting times were prolonged for 87%. Maintenance IV fluid with 2.5% dextrose was given to 14%. Overall, there was a significant increase of glycaemia from induction of anaesthesia to the end of the procedure. Hypoglycaemia was rare. The mean fasting glycaemia was 99.04 mg/dL ± 1.8, 116.95 mg/dL ± 34.2 at 30 min into the procedure and 127.62 mg/dL ± 46.8 at the end of the procedure. The differences in means were statistically significant (p < 0.001). Prolonged fasting times was associated with lower blood glucose means whereas nutrition status, type of the procedure, addition of dextrose in the fluid, and duration of procedure were associated with higher glycaemia means.ConclusionGlycaemia increases under anaesthesia and surgery. Recommended fasting times, optimising nutritional status, when possible, no dextrose or lower than 2.5% dextrose in IV maintenance fluid are possible strategies to maintain blood sugar homeostasis during paediatric surgery and anaesthesia.

Use of metformin in patients with type 2 diabetes and acute myocardial infarction: safety and impact on glycemic control

Myocardial infarction (MI) in patients with diabetes type 2 (T2DM) occurs 1.5-3.0 times higher than in general population. Metformin is contraindicated for patients with T2DM and acute coronary syndrome due to the risk of developing lactic acidosis. Using metformin more than 48 hours of MI is a topical question, which will help to improve patient's safety. To evaluate the safety and quality of glycemic control using metformin in patients with T2DM during inpatient treatment for MIMATERIALS AND METHODS: The study included 161 patients with T2DM, who were hospitalized consecutively with acute MI with ST-elevation and underwent percutaneous coronary intervention (PCI). Average time of metformin initiation was 5th day from admission. Creatinine was assessed at admission and 48 hours after PCI. The acid-base balance and lactate were assessed at admission and on the 3rd day after the start of using metformin. Criteria for the effectiveness of glycemic control was the proportion of glycemic measurements in target range of 6.1-10.0 mmol/l during hospitalization ("hospital time in range", hTIR). hTIR >55% was considered to be a critical level. The long-term outcome was estimated at 365 days after hospitalization. Metformin was prescribed to 99 patients (61%) ("M+"group) during the hospitalization, 62 patients were in "M-"group. Use of metformin was accompanied with better glycemic control in the «M+» group compared to the «M-»: mean glycemia 9.3 ± 1.6 vs 10.3 ± 2.3 mmol/l (p=0,002), SD 2.87 ± 1.1 vs 3.26 ± 1.8 (p=0,049), hTIR 60 ± 18% vs 48 ± 23% (p<0,001). There were clinically insignificant changes in acid-base balance on the 3rd day from the start of metformin use in the "M+" group, the lactate level did not increase. Use of metformin before to hospitalization with MI was not associated with an increased risk of developing acute kidney injury (AKI): RR 0.85 (0.37-1.96), p=0,691. Use of metformin in patients with T2DM and acute MI is associated with better glycemic control. Carrying out angiography in patients, treated with metformin before the hospitalization, is not accompanied by an increased risk of developing AKI. Appointment of metformin in 3-7 days after angiography does not lead to an increase level of lactate and significant deviations in acid-base balance.

The Use of a Hybrid Closed-Loop System for Glycemic Control in Two Pediatric Patients with Type 1 Diabetes Undergoing Minor Surgery

Technological progress in the treatment of type 1 diabetes requires doctors to use modern methods of insulin therapy in all areas of medicine that patients may come into contact with, including surgical interventions. The current guidelines indicate the possibility of using continuous subcutaneous insulin infusion in minor surgical procedures, but there are few reported cases of using a hybrid closed-loop system in perioperative insulin therapy. This case presentation focuses on two children with type 1 diabetes who were treated with an advanced hybrid closed-loop (AHCL) system during a minor surgical procedure. In the periprocedural period, the recommended mean glycemia and the time in range were maintained.

Continuous glucose monitoring assessment in patients suffering from anorexia nervosa reveals chronic prolonged mild hypoglycemia all over the nycthemeron.

Anorexia nervosa (AN) is an eating disorder characterised by voluntary dietary restriction leading to severe undernutrition. Hypoglycaemia is mostly described through severe case reports and is always evaluated by fasting or post-meal blood glucose, showing nothing about hypoglycaemia's length or duration. The interest of continuous interstitial glucose monitoring (CGM), largely used in diabetes mellitus, has never been evaluated in AN patients. Glycaemia cycles in AN patients were assessed using CGM over 5days and then analysed according to food intake. Mean glycaemia was within normal range. 91% of the patients presented with at least one episode with glycaemia under 70mg/dl. Within the 24h, the percentage of time spent with a glycaemia under 70mg/dl was of 20.82±3.90% with a maximum of 52%. We found 2.52±0.33 hypoglycaemia events per 24h, including 21.11±3.76% at night. CGM parameters correlated with cortisol and IGF1 plasma levels. Comparison with estimated carbohydrate intakes discriminated concordant and non-concordant estimations depending on patient. AN patients display chronic prolonged mild hypoglycaemia all over the nycthemeron despite normal fasting glycaemia. Associated adaptive increased counter-regulatory hormones might protect AN patients from deeper hypoglycaemia. CGM allowed testing food intake self-estimation reliability of AN patients and could be a very useful biofeedback tool.

ODP255 Woman With Maturity-Onset Diabetes of the Young Type 2 (MODY2) Mistakenly Diagnosed and Treated as Type 2 Diabetes Mellitus

Abstract Background MODY2 is a rare, monogenic form of diabetes, caused by mutations in the glucokinase gene (GCK), and is often misclassified as type 2 diabetes. Clinical case: A 37-year-old woman, during childhood, at the age of 9, was characterized as overweight and had a poor diet, despite being physically active. Her pediatrician diagnosed her with DM2 and started treatment with metformin. However, there was no improvement in fasting glucose levels, so the family decided to stop the medication on their own. In 2008, the patient became pregnant, presenting fasting glucose levels between 120-130 mg/dl (n&amp;lt;99 mg/dl), and continued without hypoglycemic treatment. In 2010, she resumed treatment for glycemic control having used: metformin, sulphonylurea, IDDP4, and basal insulin. Despite the various treatments tested, there was altered fasting glycemia, in the 130mg/dl range. In 2012, she increased her physical activity by training for a half marathon run. At the peak of her form, but maintaining hyperglycemia (always measuring while fasting), she started liraglutide 1.8mg. In 2019, she presented episodes of malaise during training, being indicated by her physician, to discontinue liraglutide, then starting dapagliflozin, but there was still no improvement of blood glucose levels. In August 2019, she was instructed to take the following medications: insulin degludec, liraglutide, and dapagliflozin. Current weight was 53kg, height 1,57cm and a BMI 21,5kg/. Laboratory exams were requested with the following results: A1C 6,6% (n: &amp;lt;5,7%), mean glycemia 143mg/dL (n: 70-99 mg/dL), fasting glycemia 127mg/dL (n: &amp;lt;100mg/dL), urea 24mg/dL (n: 13-43 mg/dL), creatinine 0,83mg/dL (n: 0,8-1,3 mg/dL), AST 16U/L (n: 10-34 U/L), ALT 17U/L (n 10-130 U/L), LDL 109mg/dL (n&amp;lt;100mg/dl), HDL 80mg/dL (n&amp;gt;60 mg/dL), TG 90mg/dL (n&amp;lt;150 mg/dL), total cholesterol 207mg/dL (&amp;lt;200 mg/dL). Faced with the suspicion of diabetes with different behavior than DM1 and DM2, genetic testing was requested for confirmation. In September 2019, the result arrived, pointing out a genetic change in heterozygosis in the GCK gene. This is a rare mutation that results in the depletion of the phenylalanine amino acid at position 150 of the protein glucokinase. This result confirmed the diagnose of MODY type 2. The patient was oriented to discontinue anti-hyperglycemic agents, maintain a low glycemic index diet, and daily physical exercises. Thus, she has been maintaining excellent glycemic control and adequate weight. Conclusion Suspicion and characterization of MODY through clinical history, and confirmation of diagnosis through genetic testing, is essential to avoid unnecessary or inefficient treatments, and to ensure a better quality of life for the patient. Presentation: No date and time listed

ODP211 Impact of Race and Chronic Kidney Disease on the Correlation between HbA1c and Continuous Glucose Monitoring (CGM) Glycemic Measures

Abstract Objective To determine whether the correlation between hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM) derived glycemic measures differs by patient race and stage of chronic kidney disease (CKD). Methods Two hundred thirty patients with type 1 or type 2 diabetes and a minimum of 10 days of CGM data collected with the Freestyle Libre CGM (personal or professional) immediately before measurement of HbA1c were included in this clinic-based observational study. The correlation between HbA1c and CGM derived glycemia was analyzed by race and by CKD stage. Similar analysis was performed between HbA1c and CGM derived time-in-range (TIR, glucose 70-180 mg/dL). Results Mean age ± SD of patients was 63 ± 14 years. 45.7% of patients self-identified as White, 31.3% as Asian, and 15.7% as Black; 84.3% of patients had type 2 diabetes and mean HbA1c was 7.9%. The mean [range] number of CGM days was 40.5 [10-90]. Correlation between HbA1c and CGM mean glycemia for all patients was r=0.75. Correlations for White, Asian and Black patients were 0.84, 0.75, and 0.54 respectively. Correlation between HbA1c and CGM mean glycemia among CKD stage 1, 2 and 3 was 0.894, 0.723 and 0.717, respectively (all patients, regardless of race). Correlation between HbA1c and TIR was r=-0.71 for all patients. Correlations between HbA1c and TIR for White, Asian, and Black patients were -0.78, -0.73 and -0.42, respectively. Conclusions The correlation between HbA1c and CGM mean glycemia appears to differ by race and CKD stage. These results have implications when using correlations between HbA1c and CGM mean glycemia to derive equations for the Glucose Management Indicator. Presentation: No date and time listed

Impact of Postural Corrective Training (TCP®) on overall glycemic control in diabetic middle-aged women

Introduction: Diabetes mellitus (DM) is a disease manifested by chronic hyperglycemia resulting from changes in the secretion and / or action of insulin, which can cause tissue damage. The practice of physical exercise is often recommended in the treatment of this disease because it improves glucose uptake due to increased insulin sensitivity. Objective: to evaluate the effect of Corrective Postural Training (TCP®) on the glycemic metabolism of patients with type 2 diabetes. Methods: Twenty-one women between 44 and 55 years old were divided into four groups: sedentary diabetics (SD); exercised diabetics (ED); non-diabetic exercised (NE); and non-diabetic sedentary (NS). TCP® was performed 3 times / week, for 1 hour / day, for a period of 20 weeks. Blood samples were collected pre- and post-intervention to determine cholesterol, triglycerides, HDL, fasting glycemia, glycated hemoglobin, estimated mean glycemia and cortisol. The Wilcoxon and Friedman tests were used to compare the results before and after intervention. Results: there was no significant difference in the anthropometric, biochemical and hormonal variables of all groups; however, glycated hemoglobin showed a significant difference (p &lt;0.05) in the ED group after 20 weeks. Important intragroup clinical changes were observed with return to the reference values of some of the analyzed parameters. Conclusion: The TCP® method may have contributed to the improvement of plasma levels of glycated hemoglobin in the ED group in addition to the clinical improvement of patients.

(Pre)diabetes, glycemia, and daily glucose variability are associated with retinal nerve fiber layer thickness in The Maastricht Study

Retinopathy and neuropathy in type 2 diabetes are preceded by retinal nerve fibre layer (RNFL) thinning, an index of neurodegeneration. We investigated whether glucose metabolism status (GMS), measures of glycaemia, and daily glucose variability (GV) are associated with RNFL thickness over the entire range of glucose tolerance. We used cross-sectional data from The Maastricht Study (up to 5455 participants, 48.9% men, mean age 59.5 years and 22.7% with type 2 diabetes) to investigate the associations of GMS, measures of glycaemia (fasting plasma glucose [FPG], 2-h post-load glucose [2-h PG], HbA1c, advanced glycation endproducts [AGEs] assessed as skin autofluorescence [SAF]) and indices of daily GV (incremental glucose peak [IGP] and continuous glucose monitoring [CGM]-assessed standard deviation [SD]) with mean RNFL thickness. We used linear regression analyses and, for GMS, P for trend analyses. We adjusted associations for demographic, cardiovascular risk and lifestyle factors, and, only for measures of GV, for indices of mean glycaemia. After full adjustment, type 2 diabetes and prediabetes (versus normal glucose metabolism) were associated with lower RNFL thickness (standardized beta [95% CI], respectively − 0.16 [− 0.25; − 0.08]; − 0.05 [− 0.13; 0.03]; Ptrend = 0.001). Greater FPG, 2-h PG, HbA1c, SAF, IGP, but not CGM-assessed SD, were also associated with lower RNFL thickness (per SD, respectively − 0.05 [− 0.08; − 0.01]; − 0.06 [− 0.09; − 0.02]; − 0.05 [− 0.08; − 0.02]; − 0.04 [− 0.07; − 0.01]; − 0.06 [− 0.12; − 0.01]; and − 0.07 [− 0.21; 0.07]). In this population-based study, a more adverse GMS and, over the entire range of glucose tolerance, greater glycaemia and daily GV were associated with lower RNFL thickness. Hence, early identification of individuals with hyperglycaemia, early glucose-lowering treatment, and early monitoring of daily GV may contribute to the prevention of RNFL thinning, an index of neurodegeneration and precursor of retinopathy and neuropathy.

Characterization of Post-Hypoglycemic Hyperglycemia in Children and Adolescents With Type 1 Diabetes: The EPHICA Study

BackgroundIn patients with diabetes, the dynamics in which hypoglycemia recovers impacts cardiovascular disease risk. Our study investigated the extents of “post-hypoglycemic hyperglycemia (PHH)” (i.e. hypoglycemia that recover to hyperglycemia in any circumstance) and factors likely to influence PHH characteristics in a pediatric cohort of patients with type 1 diabetes (T1D).MethodsWe collected retrospective continuous glucose monitoring (CGM) data from 142 pediatric patients with T1D to characterize episodes of PHH during a two-month follow-up period. Factors influencing PHH were determined using univariate and multivariate analyses.ResultsIn our EPHICA cohort, PHH rate was 0.6 ± 0.3 episode/day and correlated (r=0.33; p<0.0001) with hyperglycemia rate (2.6 ± 0.5 episodes/day). The global proportion of hyperglycemia corresponding to PHH was 0.22 ± 0.1, yet 14.8% of patients had more than 1/3 of hyperglycemia related to PHH. Episodes of PHH lasted 239.6 ± 124.8 minutes with a hyperglycemic peak of 258.8 ± 47.1 mg/dL. Only 12.2% of PHH occurred at night. While a younger age (<12 years) and lower body mass index (BMI) (SDS: -2 to 1.6) were associated with higher daily PHH rates, teenagers (≥12 years) and obese patients experienced longer PHH and higher hyperglycemic peaks. Parameters of glycemic variability (i.e. HbA1C, IDAA1C and GTAA1C) moderately correlated with PHH duration and related hyperglycemic peak. Multivariate analysis confirmed these results, as factors likely to influence PHH rate were phenotype (age and BMI) and glycemic variability parameters (time in range, mean glycemia, HbA1C and GTAA1C).ConclusionOur EPHICA study highlights the importance of PHH as a prominent component of hyperglycemia in some children and adolescents with T1D. Factors associated with PHH features are age, BMI and parameters of glycemic control. Young and lean children are more prone to experience hypoglycemia that recover with hyperglycemia, but adolescents and obese children tend to experience hyperglycemia of longer duration.

677-P: Impact of Third Dose COVID-Vaccination on Glycaemic Control in Individuals with Type 1 Diabetes Using Flash Glucose Monitoring

Background: Coronavirus (COVID-19) disease portends a poor prognosis in patients with type 1 diabetes (T1D) . As a consequence, the booster dose of Covid-vaccination should be prioritized in these patients. Nonetheless, concerns exist about vaccine-induced dysglycemia. Objectives: Aim of this study was to assess the short-term effects of booster dose of Covid-vaccination on glycaemic control assessed by flash glucose monitoring (FGM) in people with T1D. Methods: In this observational cross-sectional study we investigated changes in daily insulin requirement (IR) and glycaemic control between 7 days before and 7 days after the third dose of vaccination with BioNTech Pfizer among 30 individuals with T1D on multiple daily insulin injections wearing a flash glucose monitoring (FGM) device. The following parameters of glycaemic variability were analysed: mean glucose, time in range (TIR) , time above range (TAR) , time below range (TBR) and coefficient of variation (CV) . Results: No significant differences were found for mean glycemia, TIR, TAR and TBR over the course of the vaccination from 7 days prior to receiving the third-dose vaccination until 7 days after. Nonetheless, CV and IR were significantly higher (CV, p-value = 0.001; IR, p-value = 0.05) in the week after the vaccination compared to the week earlier. The median value of CV was 35.5% [33-37] before and 36.9% [34-39] after the booster dose, whereas the median value of IR changed from 0.55 UI/Kg/day to 0.61 UI/Kg/day. Conclusions: Our study suggests that the booster dose of Covid-vaccination impact on glycaemic variability and insulin requirement in people with T1D, probably due to the pro-inflammatory cytokines and immune responses. While this observation should be investigated in larger studies, potential glycaemic aberrations in response to Covid-immunization should be considered by health care professionals and glucose monitoring intensified within the days around the vaccination. Disclosure S.Pieralice: None. L.Monte: None. G.Defeudis: None. G.Tabacco: None. N.Napoli: Advisory Panel; Novo Nordisk, Consultant; Lilly Diabetes. P.Pozzilli: Advisory Panel; Dompé, Consultant; Abbott, Speaker’s Bureau; Dompé, Lilly Diabetes, Medtronic, Sanofi.