title: Persistently high glucose levels in young children with type 1 diabetes.
abstract: OBJECTIVE
  The aim of the study was to characterize glucose levels and variability in young children with type 1 diabetes (T1D).
  
  
  METHODS
  A total of 144 children of 4-10 yr old diagnosed with T1D prior to age 8 were recruited at five DirecNet centers. Participants used a continuous glucose monitor (CGM) every 3 months during an 18-month study. Among the 144 participants, 135 (mean age 7.0 yr, 47% female) had a minimum of 48 h of CGM data at more than five of seven visits and were included in analyses. CGM metrics for different times of day were analyzed.
  
  
  RESULTS
  Mean hemoglobin A1c (HbA1c) at the beginning and end of the study was 7.9% (63 mmol/mol). Fifty percent of participants had glucose levels >180 mg/dL (10.0 mmol/L) for >12 h/d and >250 mg/dL (13.9 mmol/L) for >6 h/d. Median time <70 mg/dL (3.9 mmol/L) was 66 min/d and <60 mg/dL (3.3 mmol/L) was 39 min/d. Mean amplitude of glycemic excursions (MAGE) was lowest overnight (00:00-06:00 hours). The percent of CGM values 71-180 mg/dL (3.9-10.0 mmol/L) and the overall mean glucose correlated with HbA1c at all visits. There were no differences in CGM mean glucose or coefficient of variation between the age groups of 4 and <6, 6 and <8, and 8 and <10.
  
  
  CONCLUSIONS
  Suboptimal glycemic control is common in young children with T1D as reflected by glucose levels in the hyperglycemic range for much of the day. New approaches to reduce postprandial glycemic excursions and increase time in the normal range for glucose in young children with T1D are critically needed. Glycemic targets in this age range should be revisited.
authors.affiliation: Pediatric Endocrinology, University of Iowa, Iowa City, IA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Tansey
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA.
authors.forename: R
authors.initials: R
authors.lastname: Beck
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA.
authors.forename: K
authors.initials: K
authors.lastname: Ruedy
authors.affiliation: Pediatric Endocrinology, Yale University, New Haven, CT, USA.
authors.forename: W
authors.initials: W
authors.lastname: Tamborlane
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA.
authors.forename: P
authors.initials: P
authors.lastname: Cheng
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA.
authors.forename: C
authors.initials: C
authors.lastname: Kollman
authors.affiliation: Pediatric Endocrinology, Nemours Children's Clinic, Jacksonville, FL, USA.
authors.forename: L
authors.initials: L
authors.lastname: Fox
authors.affiliation: Pediatric Endocrinology, Yale University, New Haven, CT, USA.
authors.forename: S
authors.initials: S
authors.lastname: Weinzimer
authors.affiliation: Pediatric Endocrinology, Nemours Children's Clinic, Jacksonville, FL, USA.
authors.forename: N
authors.initials: N
authors.lastname: Mauras
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: N H
authors.initials: NH
authors.lastname: White
authors.affiliation: Pediatric Endocrinology, University of Iowa, Iowa City, IA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Tsalikian
mesh_terms: D000367:Age Factors; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D001786:Blood Glucose
keywords: continuous glucose monitoring; pediatric; type 1 diabetes