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A Study by Dr. Benjamin Nwosu Shows Continuous Glucose Monitors Reduced Pubertal Hyperglycemia in Type 1 Diabetes

Date Posted: Wednesday, July 15, 2020

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According to current estimates, less than 21% of children living with type 1 diabetes (T1D) meet the American Diabetes Association (ADA) goal of an A1c test result at or below 7.5%.  During puberty, a phenomenon called physiologic hyperglycemia of puberty (PHOP) results in uncontrolled high blood sugar in young people with T1D.  PHOP is a major contributor to persistent poor blood sugar control in youth living with T1D, and it’s been reported in landmark studies such as the Diabetes Control and Complications Trial and T1D Exchange studies.

Dr. Benjamin Nwosu, professor of pediatrics and pediatric endocrinologist at the UMass Memorial Diabetes Center of Excellence, led a newly published study in the Journal of Pediatric Endocrinology and Metabolism, titled “Continuous glucose monitoring reduces pubertal hyperglycemia of type 1 diabetes.”

The study examined blood glucose data of 105 pediatric T1D patients from the Children’s Medical Center Database at UMass Memorial Medical Center.  Patients in the continuous glucose monitor (CGM) group showed evidence of consistent CGM use more than 80% of the time for at least a year.

Recent improvements in CGM technology has led to increased use by children and adolescents with T1D.  Mixed population studies of both children and adults have reported improved blood glucose outcomes in a combined age group of 14 to 75 year olds who are using hybrid closed-loop therapy (insulin pumps that communicate with CGMs) as well as those who are only using CGM.

In those studies, the effect of CGM use on PHOP was not fully examined.  Dr. Nwosu’s research was a 12-month case-control study to determine the effect of CGM use during puberty in 54 youth with T1D, compared to 51 children who did not use CGM to monitor their blood glucose.

“The goal of our study was to determine the effectiveness of CGM to improve glycemic control in pubertal youth with T1D compared to a non-CGM group,” said Dr. Nwosu.  “Our hypothesis was that consistent CGM use in puberty improves compliance with diabetes management, leading to increased time in goal blood sugar range, and ultimately a lower A1c.”

The results of his study show A1c was significantly lower in the CGM group after 12 months.  “This suggests that wearing a CGM and having access to real-time blood glucose data may trigger behavioral changes that could lessen the magnitude of hyperglycemia during puberty,” said Dr. Nwosu. 

Also, his research data found CGM users had no change in A1c from a young age through puberty and older, whereas those who did not use a CGM experienced an increase in A1c with increasing age and pubertal status.

“This real-time, glucose-data driven approach to diabetes management could provide the basis for a well-calibrated insulin dosing regimen to reduce insulin resistance and reduce the magnitude of insulin resistance-mediated PHOP,” said Dr. Nwosu. “It’s encouraging to see data showing improved glycemic control and lower A1c during the phase of persistent hyperglycemia of puberty in what is traditionally a non-compliant population.”

Video and Resources for Families of Children Living with Diabetes

The UMass Diabetes Center of Excellence offers a variety of information and resources for children and families affected by diabetes. View our educational videos and learn more here.