Clinical targets for continuous glucose monitoring data interpretation : recommendations from the international consensus on time in range

Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations

Retinal Vascular Caliber and Risk of Retinopathy in Young Patients with Type 1 Diabetes

10.1016/j.ophtha.2006.05.009Ophthalmology11391499-1503OPHT

Vitamin D deficiency is not associated with changes in retinal geometric parameters in young people with type 1 diabetes

10.1155/2013/280691Journal of Diabetes Research201

Retinal arteriolar tortuosity is associated with retinopathy and early kidney dysfunction in type 1 diabetes

10.1016/j.ajo.2011.06.005American Journal of Ophthalmology1531176-183.e1AJOP

Retinal vascular fractal dimension and risk of early diabetic retinopathy: A prospective study of children and adolescents with type 1 diabetes

10.2337/dc09-0719Diabetes Care32112081-2083DICA

Type 2 diabetes in children and adolescents across Australia and New Zealand: A 6-year audit from The Australasian Diabetes Data Network (ADDN)

Objectives: To assess the clinical and demographic characteristics of children andadolescents across Australia and New Zealand (NZ) with type 2 diabetes. Methods: We performed a descriptive audit of data prospectively reported to the Australasian Diabetes Data Network (ADDN) registry. Data were collected from six tertiary pediatric diabetes centers across Australia (New South Wales, Queensland,South Australia, Western Australia, and Victoria) and NZ (Auckland). Children and adolescents diagnosed with type 2 diabetes aged≤18 years with data reported to ADDN between 2012 and 2017 were included. Age, sex, ethnicity, HbA1c, blood pressure, BMI, waist circumference and lipid profile at first visit were assessed. Results: There were 269 cases of type 2 diabetes in youth reported to ADDN between 2012 and 2017. The most common ethnicities were Indigenous Australian in 56/243 (23%) and NZ Maori or Pacifica in 47 (19%). Median age at diagnosis was13.7 years and 94% of participants were overweight or obese. Indigenous Australian and Maori/Pacifica children were younger at diagnosis compared with nonindigenous children: median 13.3 years (indigenous Australian); 13.1 years (Maori/Pacifica);14.1 years (nonindigenous),p= 0.005. HbA1c was higher in indigenous Australian(9.4%) and Maori/Pacifica youth (7.8%) compared with nonindigenous (6.7%)p< 0.001. BMI-SDS was higher in Maori/Pacifica youth (2.3) compared with indigenous Australian (2.1) and nonindigenous (2.2)p= 0.011. Conclusions: Indigenous Australian and Maori/Pacifica youth in ADDN were younger and had worse glycaemic control at diagnosis of type 2 diabetes. Our findings under-score the need to consider targeted and earlier screening in these “high-risk” populations.Karissa Ludwig, Maria E. Craig, Kim C. Donaghue, Ann Maguire, Paul Z. Benitez-Aguirre, The ADDN Study Grou

Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort

Aims/hypothesis We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control. Methods This was a prospective observational study in 710 normoalbuminuric adolescents with type 1 diabetes from the nonintervention cohorts of the Adolescent Cardio-Renal Intervention Trial (AdDIT). Participants were classified as ‘high ACR’ or ‘low ACR’ (lowest and middle ACR tertiles) using baseline standardised log10 ACR. The primary outcome, 3DR, was determined from centrally graded, standardised two-field retinal photographs. 3DR risk was determined using multivariable Cox regression for the effect of high ACR, with HbA1c, BP, LDL-cholesterol and BMI as covariates; diabetes duration was the time-dependent variable. Results At baseline mean ± SD age was 14.3 ± 1.6 years and mean ± SD diabetes duration was 7.2 ± 3.3 years. After a median of 3.2 years, 83/710 (12%) had developed 3DR. In multivariable analysis, high ACR (HR 2.1 [1.3, 3.3], p=0.001), higher mean IFCC HbA1c (HR 1.03 [1.01, 1.04], p=0.001) and higher baseline diastolic BP SD score (HR 1.43 [1.08, 1.89], p=0.01) were independently associated with 3DR risk. Conclusions/interpretation High ACR is associated with greater risk of 3DR in adolescents, providing a target for future intervention studies. Trial registration isrctn.org ISRCTN91419926.Paul Z. Benitez-Aguirre, M. Loredana Marcovecchio, Scott T. Chiesa, Maria E. Craig, Tien Y. Wong, Elizabeth A. Davis, Andrew Cotterill, Jenny J. Couper, Fergus J. Cameron, Farid H. Mahmud, H. Andrew W. Neil, Timothy W. Jones, Lauren A. B. Hodgson, R. Neil Dalton, Sally M. Marshall, John Deanfield, David B. Dunger, Kim C. Donaghu

Determinants of cardiovascular risk in 7,000 youth with type 1 diabetes in the Australasian Diabetes Data Network

CONTEXT:Cardiovascular disease occurs prematurely in type 1 diabetes. The additional risk of overweight is not well characterised. OBJECTIVE:Primary aim was to measure the impact of BMI in youth with type 1 diabetes on cardiovascular risk factors. Secondary aim was to identify other determinants of cardiovascular risk. DESIGN:Observational longitudinal study of 7061 youth with type 1 diabetes followed for median 7.3 (IQR 4-11) years over 41 (IQR 29-56) visits until March 2019. SETTING:15 tertiary care diabetes centres in the Australasian Diabetes Data Network. PARTICIPANTS:aged 2 - 25 years at baseline, with at least two measures of BMI and blood pressure. MAIN OUTCOME MEASURE:Standardised systolic and diastolic blood pressure scores and non-HDL cholesterol were co-primary outcomes. Urinary albumin/creatinine ratio was the secondary outcome. RESULTS:BMI z-score related independently to standardised blood pressure z- scores and non-HDL cholesterol. An increase in 1 BMI z-score related to an average increase in systolic/diastolic blood pressure of 3.8/1.4mmHg and an increase in non -HDL cholesterol (coefficient + 0.16mmol/L, 95%CI 0.13-0.18; p<0.001) and in LDL cholesterol. Females had higher blood pressure z-scores, higher non-HDL and LDL cholesterol, and higher urinary albumin/creatinine than males. Indigenous youth had markedly higher urinary albumin/creatinine (coefficient +2.15 mg/mmol, 95% CI 1.27-3.03; p<0.001) and higher non-HDL cholesterol than non-indigenous youth. Continuous subcutaneous insulin infusion was associated independently with lower non-HDL cholesterol and lower urinary albumin/creatinine. CONCLUSIONS:BMI had a modest independent effect on cardiovascular risk. Females and indigenous Australians in particular had a more adverse risk profile.Jenny J Couper, Timothy W Jones, Melissa Chee, Helen L Barrett, Philip Bergman, Fergus Cameron ... et al

Longitudinal audit of assessment and pharmaceutical intervention for cardiovascular risk in the Australasian Diabetes Data Network

OnlinePubl.Abstract not available.Claire A. Robertson, Arul Earnest, Melissa Chee, Maria E. Craig, Peter Colman, Helen L. Barrett, Philip Bergman, Fergus Cameron, Elizabeth A. Davis, Kim C. Donaghue, P. Gerry Fegan, P. Shane Hamblin, D. Jane Holmes–Walker, Craig Jefferies, Stephanie Johnson, Meng T. Mok, Bruce R. King, Richard Sinnott, Glenn Ward, Benjamin J. Wheeler, Anthony Zimmermann, Timothy W. Jones, Jenny J. Couper, the ADDN Study Grou