Early dysglycemia is detectable using continuous glucose monitoring in very young children at risk of type 1 diabetes

Objective Continuous glucose monitoring (CGM) can detect early dysglycemia in older children and adults with pre-symptomatic type 1 diabetes and predict risk of progression to clinical onset. However, CGM data for very young children at greatest risk of disease progression are lacking. This study aimed to investigate the use of CGM data measured in children being longitudinally followed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study from birth to 10 years. Research Design and Methods Between January 2021 and June 2023, 31 ENDIA children with persistent multiple islet autoimmunity (PM Ab+) and 24 age-matched controls underwent CGM assessment alongside standard clinical monitoring. The CGM metrics of glucose standard deviation (SDSGL), coefficient of variation (CEV), mean sensor glucose (SGL) and percent time above 7.8 mmol/L (140mg/dL) were determined and examined for between group differences. Results The mean(SD) age of PM Ab+ and Ab- children was 4.4(1.8) and 4.7(1.9) years, respectively. Eighty-six percent of eligible PM Ab+ children consented to CGM wear, achieving a median[Q1,Q3] sensor wear period of 12.5[9.0, 15.0] days. PM Ab+ children had higher median[Q1,Q3] SDSGL (1.1[0.9,1.3] vs 0.9[0.8,1.0] (mmol/L); p<0.001) and CEV (17.3[16.0,20.9] vs 14.7[12.9,16.6](%); p<0.001). Percent time >7.8 mmol/L was greater in PM Ab+ children (median[Q1,Q3] 8.0 [4.4, 13.0] vs 3.3[1.4, 5.3] (%); p=0.005). Mean SGL did not differ significantly between groups (p=0.10). Conclusions CGM is feasible and well tolerated in very young type 1 diabetes at-risk children. Very young PM Ab+ children have increased SDSGL, CEV and percent time >7.8 mmol/L, consistent with prior studies involving older participants.