Early Dysglycemia Is Detectable Using Continuous Glucose Monitoring in Very Young Children at Risk of Type 1 Diabetes
Authors: Haynes Aveni , Tully Alexandra , Smith Grant J. , Penno Megan A.S. , Craig Maria E. , Wentworth John M. , Huynh Tony , Colman Peter G. , Soldatos Georgia , Anderson Amanda J. , McGorm Kelly J. , Oakey Helena , Couper Jennifer J. , Davis Elizabeth A. ,   ENDIA Study Group, Barry Simon C. , Craig Maria E. , Colman Peter G. , Couper Jennifer J. , Davis Elizabeth A. , Hamilton-Williams Emma , Harrison Leonard C. , Haynes Aveni , Huynh Tony , Kim Ki Wook , Morahan Grant , Oakey Helena , Penno Megan A.S. , Rawlinson William D. , Sinnott Richard O. , Soldatos Georgia , Thomson Rebecca L. , Tye-Din Jason , Vuillermin Peter J. , Wentworth John M. , Cameron Fergus , Day Andrew , Lopez Prudence , Anderson Amanda J. , Ashwood Pat , Brown James D. , Hu William , Huynh Dao , McGorm Kelly J. , Watson Kelly , Beresford Sarah , Bezuidenhout Debra , Brandrick Susan , Butterworth Carlie , Catteau Jacki , Griffiths Helen , Gwiazdzinski Alison , Hall Candice , Hulley Amanda , Henneken Lee , Kludas Renee , Mateevici Ying , Ramoso Benjamin , Roberts Alison , Tully Alexandra , Wood Rosemary , Binkowski Sabrina , Bui Minh , Gilbert Abbey , Huang Dexing , Karceva Ana , Mellor Brydie-Rose , Naselli Gaetano , Ngui Katrina , Nguyen Trung , Patel Bina , Prajitno Vanessa , Stone Natalie , Tran Thao , Vaega Sapphire , Ward Emily , Xu Yan , Yau Cynthia , Battersby Rachel , Brittain Bek , Foster Charles , Hope Christopher , Leung Preston , Mallitt Kylie-Ann , Roth-Schulze Alexandra , Sadlon Tim , Tillett Bree , Walker Gregory , Wong Ying , Zozaya-Valdes Enrique , Cavenett Leanne 
Published: August 2024

OBJECTIVE
Continuous glucose monitoring (CGM) can detect early dysglycemia in older children and adults with presymptomatic type 1 diabetes (T1D) 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 observed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study from birth to age 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 control children underwent CGM assessment alongside standard clinical monitoring. The CGM metrics of glucose SD (SDSGL), coefficient of variation (CEV), mean sensor glucose (SGL), and percentage of time &gt;7.8 mmol/L (&gt;140 mg/dL) were determined and examined for between-group differences.

RESULTS
The mean (SD) ages of PM Ab+ and Ab− children were 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 (quartile 1 [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 &lt; 0.001) and CEV (17.3% [16.0, 20.9] vs. 14.7% [12.9, 16.6]; P &lt; 0.001). Percentage of time &gt;7.8 mmol/L was greater in PM Ab+ children (median [Q1, Q3] 8.0% [4.4, 13.0] compared with 3.3% [1.4, 5.3] in Ab− children; P = 0.005). Mean SGL did not differ significantly between groups (P = 0.10).

CONCLUSIONS
CGM is feasible and well tolerated in very young children at risk of T1D. Very young PM Ab+ children have increased SDSGL, CEV, and percentage of time &gt;7.8 mmol/L, consistent with prior studies involving older participants.