Residual β-Cell Function Is Associated With Longer Time in Range in Individuals With Type 1 Diabetes

Diabetes Care, vol. 47, pp. 1114–1121

Abstract

OBJECTIVE: Little is known about the influence of residual islet function on glycemic control in type 1 diabetes (T1D). We investigated the associations between residual β-cell function and metrics of continuous glucose monitoring (CGM) in individuals with T1D. RESEARCH DESIGN AND METHODS: In this cross-sectional cohort comprising 489 individuals (64% female, age 41.0 ± 14.0 years), T1D duration was 15.0 (interquartile range [IQR] 6.0-29.0) years. Individuals had a time in range (TIR) of 66% (IQR 52-80%) and a urinary C-peptide-to-creatinine ratio (UCPCR) of 0.01 (IQR 0.00-0.41) nmol/mmol. To assess β-cell function, we measured UCPCR (detectable >0.01 nmol/mmol), and to assess α-cell function, fasting plasma glucagon/glucose ratios were measured. CGM was used to record TIR (3.9-10 mmol/L), time below range (TBR) (<3.9 mmol/L), time above range (TAR) (>10 mmol/L), and glucose coefficient of variance (CV). For CGM, 74.7% used FreeStyle Libre 2, 13.8% Medtronic Guardian, and 11.5% Dexcom G6 as their device. RESULTS: The percentage of patients with T1D who had a detectable UCPCR was 49.4%. A higher UCPCR correlated with higher TIR (r = 0.330, P < 0.05), lower TBR (r = -0.237, P < 0.05), lower TAR (r = -0.302, P < 0.05), and lower glucose CV (r = -0.356, P < 0.05). A higher UCPCR correlated negatively with HbA1c levels (r = -0.183, P < 0.05) and total daily insulin dose (r = -0.183, P < 0.05). Glucagon/glucose ratios correlated with longer TIR (r = 0.234, P < 0.05). CONCLUSIONS: Significantly longer TIR, shorter TBR and TAR, and lower CV were observed in individuals with greater UCPCR-assessed β-cell function. Therefore, better CGM-derived metrics in individuals with preserved β-cell function may be a contributor to a lower risk of developing long-term complications.

Authors 16

1. Coco M. Fuhri Snethlage corresponding

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   1Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands

2. Timothy James McDonald

   Peninsula College of Medicine and Dentistry

   Affiliation as printed

   2Peninsula College of Medicine and Dentistry, Peninsula National Institute for Health and Care Research Clinical Research Facility, Exeter, Devon, U.K

   Peninsula College of Medicine and Dentistry, Peninsula National Institute for Health and Care Research Clinical Research Facility, Exeter, Devon, United Kingdom

3. Richard A. Oram

   Peninsula College of Medicine and Dentistry

   Affiliation as printed

   2Peninsula College of Medicine and Dentistry, Peninsula National Institute for Health and Care Research Clinical Research Facility, Exeter, Devon, U.K

   Peninsula College of Medicine and Dentistry, Peninsula National Institute for Health and Care Research Clinical Research Facility, Exeter, Devon, United Kingdom

4. Pleun de Groen

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   1Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands

5. Elena Rampanelli

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   1Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands

6. Alinda W.M. Schimmel

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   1Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands

7. Frits Holleman

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   1Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands

8. Sarah E. Siegelaar

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   1Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands

9. Joost Hoekstra

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   1Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands

10. Catherine B. Brouwer

    OLVG

    Affiliation as printed

    3Onze Lieve Vrouwe Gasthuis, Oost, Amsterdam, the Netherlands

11. Filip Krag Knop

    University of Copenhagen · Gentofte Hospital · Steno Diabetes Center Copenhagen

    Affiliation as printed

    4Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark

    5Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    6Steno Diabetes Center Copenhagen, Herlev, Denmark

    7Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

12. C. Bruce Verchere

    BC Children's Hospital Research Institute

    Affiliation as printed

    8BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada

13. Daniël H. van Raalte

    Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

    Affiliation as printed

    9Department of Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands

14. Bart O. Roep Aachen 10Internal Medicine

    Leiden University Medical Center

    Affiliation as printed

    10Internal Medicine, Leids Universitair Medisch Centrum, Leiden, the Netherlands

15. Max Nieuwdorp

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    1Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands

16. Nordin M.J. Hanssen

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    1Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands