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. 2024 Jun 18:15:1388245.
doi: 10.3389/fendo.2024.1388245. eCollection 2024.

Glycemic variability through the perspective of the glycemia risk index and time in range and their association with glycated hemoglobin A1c in pediatric patients on sensor-augmented pump therapy

Gordana Bukara-Radujkovic  1   2 , Vesna Miljkovic  1
Affiliations

Glycemic variability through the perspective of the glycemia risk index and time in range and their association with glycated hemoglobin A1c in pediatric patients on sensor-augmented pump therapy

Gordana Bukara-Radujkovic et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: From the introduction of continuous glucose monitoring (CGM) in treatments of type 1 diabetes, particularly its integration with insulin pumps, there has been a quest for new parameters that describe optimal glycemic control. As of the consensus reached in 2019, the ambulatory glucose profile (AGP) has become the standard, with time in range (TIR) emerging as a fundamental parameter for metabolic control assessment. However, with technological advancements, new parameters, such as the glycemia risk index (GRI), have been introduced and clinically utilized. Therefore, exploring the relationships between traditional and novel parameters to understand metabolic control comprehensively is imperative.

Materials and methods: This study was conducted at the Pediatric Clinic of the University Hospital of the Republic of Srpska Banja Luka between January and July 2023. The participants were randomly selected, with the inclusion criteria specifying an age greater than eight years and a diabetes type 1 duration exceeding two years. All participants were required to use a sensor-augmented insulin pump for the next three months (90 days), irrespective of prior use, with the suspend-before-low option activated.

Results: Of the 35 participants, 30 completed the study, 14 (46.7%) of whom were male. The mean age of the subjects was 14.90 ± 2.88 years, and the mean duration of diabetes was 7.83 ± 4.76 years. Over the 90-day period, HbA1c increased to an average of 7.31%. The analysis revealed significant effects of TIR (β=-0.771) and GRI (β=0.651) on HbA1c. Furthermore, GRI and TIR strongly correlated (β=-0.953).

Discussion and conclusion: New parameters generated from the ambulatory glucose profile (AGP) can help clinicians create a complete picture of a patient's metabolic control in relation to HbA1c levels. Additionally, the GRI is a mathematically tailored parameter that incorporates all components of the ambulatory glucose profile and demonstrates strong correlations with laboratory-measured HbA1c and TIR. The GRI potentially can become a valuable statistical parameter for evaluating and managing patients in routine clinical practice.

Keywords: continuous glucose monitoring; glycemia risk index; glycemic variability; pediatric diabetes; time in range.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Research scheme.
Figure 2
Figure 2
Linear regression model where the HbA1c is dependent variable and the Time In Range – TIR (A), and Glycemia Risk Index – GRI (B) are independent variable.
Figure 3
Figure 3
Linear regression model of Time In Range - TIR as dependent and Glycemia Risk Index - GRI as independent variable.
See this image and copyright information in PMC

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Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.