Evidence mapPaperPMID 30972889Full record

Trial reportPediatric diabetes2019

Identification of clinically relevant dysglycemia phenotypes based on continuous glucose monitoring data from youth with type 1 diabetes and elevated hemoglobin A1c.

Anna R Kahkoska, Linda A Adair, Allison E Aiello, Kyle S Burger, John B Buse, Jamie Crandell, David M Maahs, Crystal T Nguyen, Michael R Kosorok, Elizabeth J Mayer-Davis

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Pediatric diabetes, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Anna R KahkoskaDepartment of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.ORCID 0000-0003-2701-101X
Linda A AdairDepartment of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Allison E AielloDepartment of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Kyle S BurgerDepartment of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
John B BuseDepartment of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Jamie CrandellSchool of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
David M MaahsDepartment of Pediatrics, School of Medicine, Stanford University, Stanford, California.
Crystal T NguyenDepartment of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Michael R KosorokDepartment of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Elizabeth J Mayer-DavisDepartment of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.ORCID 0000-0003-3858-0517

Funding

UNC-CH CENTER FOR ENVIRONMENTAL HEALTH &SUSCEPTIBILITYP30ES010126 · UNIV OF NORTH CAROLINA CHAPEL HILL · 2001 to 2025
$6.9M
UNIV OF NORTH CAROLINA CLINICAL NUTRITION RESEARCH UNITP30DK056350 · UNIV OF NORTH CAROLINA CHAPEL HILL · 1999 to 2025
$5.9M
Stanford Islet Research CoreP30DK116074 · STANFORD UNIVERSITY · 2025 to 2025
$2.0M
NCATS NIH HHS UL1 TR002489NIDDK NIH HHS 1UC4DK101132NIDDK NIH HHS F30 DK113728NIDDK NIH HHS F30DK113728NIDDK NIH HHS P30 DK056350NIDDK NIH HHS P30 DK116074NIDDK NIH HHS P30DK116074NIDDK NIH HHS UC4 DK101132NIEHS NIH HHS P30 ES010126NIH HHS UL1TR002489
6 · The paper itself

Abstract

BACKGROUND/

objectiveTo identify and characterize subgroups of adolescents with type 1 diabetes (T1D) and elevated hemoglobin A1c (HbA1c) who share patterns in their continuous glucose monitoring (CGM) data as "dysglycemia phenotypes."

methodsData were analyzed from the Flexible Lifestyles Empowering Change randomized trial. Adolescents with T1D (13-16 years, duration >1 year) and HbA1c 8% to 13% (64-119 mmol/mol) wore blinded CGM at baseline for 7 days. Participants were clustered based on eight CGM metrics measuring hypoglycemia, hyperglycemia, and glycemic variability. Clusters were characterized by their baseline features and 18 months changes in HbA1c using adjusted mixed effects models. For comparison, participants were stratified by baseline HbA1c (≤/>9.0% [75 mmol/mol]).

resultsThe study sample included 234 adolescents (49.8% female, baseline age 14.8 ± 1.1 years, baseline T1D duration 6.4 ± 3.7 years, baseline HbA1c 9.6% ± 1.2%, [81 ± 13 mmol/mol]). Three Dysglycemia Clusters were identified with significant differences across all CGM metrics (P < .001). Dysglycemia Cluster 3 (n = 40, 17.1%) showed severe hypoglycemia and glycemic variability with moderate hyperglycemia and had a lower baseline HbA1c than Clusters 1 and 2 (P < .001). This cluster showed increases in HbA1c over 18 months (p-for-interaction = 0.006). No other baseline characteristics were associated with Dysglycemia Clusters. High HbA1c was associated with lower pump use, greater insulin doses, more frequent blood glucose monitoring, lower motivation, and lower adherence to diabetes self-management (all P < .05).

conclusionsThere are subgroups of adolescents with T1D for which glycemic control is challenged by different aspects of dysglycemia. Enhanced understanding of demographic, behavioral, and clinical characteristics that contribute to CGM-derived dysglycemia phenotypes may reveal strategies to improve treatment.

Indexed as

AdolescentBlood GlucoseDiabetes Mellitus, Type 1FemaleGlycated HemoglobinHumansMalePhenotypeWearable Electronic DevicesBlood GlucoseGlycated Hemoglobinhemoglobin A1c protein, humanadolescentcontinuous glucose monitoringhypoglycemiatype 1 diabetes

Identifiers

PMID30972889
PMCPMC6625874

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.