Continuous Subcutaneous Glucose Monitoring (CGM) to predict progression from abnormal glucose tolerance (Pre-diabetes) to Type 2 Diabetes Mellitus

Price, Sally Ann 2016. Continuous Subcutaneous Glucose Monitoring (CGM) to predict progression from abnormal glucose tolerance (Pre-diabetes) to Type 2 Diabetes Mellitus. MD Thesis, Cardiff University. Item availability restricted.

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Abstract

The global incidence of Type 2 Diabetes Mellitus (T2DM) is increasing rapidly. Many people with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) will however not progress to T2DM but appear to spontaneous revert to normal glucose homeostasis, others however will progress slowly and in some cases rapidly progress towards diabetes. Therapeutic interventions will reduce the risk, or at least the pace, of deterioration from IFG and IGT to T2DM. However, in order to target interventions appropriately, to prevent progression in those at greatest risk further information as to which individuals are most likely to progress is needed. There is a variable rate of progression from either IFG, IGT or combined IFG and IGT to T2DM and in general, progression rates are lowest in the general population and highest in target “at-risk” group. Age, body mass index (BMI), fasting and 2 hour plasma glucose concentrations, elevated fasting pro-insulin, low 2-hour insulin and fasting triglyceride levels are known to be associated with a greater risk of progression and in order to maintain normoglycemia, adequate quantitative and qualitative moment-by-moment pancreatic beta-cell secretion and action is essential. A marker of deteriorating carbohydrate homeostasis would be increased fluctuations in blood glucose levels and continuous glucose monitoring (CGM) is an ideal method to look at just this. The use of CGM to quantify the fluctuations was proposed to assess whether CGM can help identify people with abnormal glucose tolerance that progress to T2DM. In this study, CGM profiles inspected by eye for variability appeared to correlate well with mathematically devised CGM parameters based on CGM data, both at baseline and at Year 1. However, neither the subject CGM profiles nor the CGM parameters at baseline were significant in predicting progression to diabetes (T2DM) at Year 1 or Year 3 from a pre diabetic state at baseline. However, when one looked at progression from pre diabetes to diabetes, with regard to CGM profiles and CGM parameters, the interval period between study baseline and Year 1 appeared to be when most variation in glucose levels occurred; this was especially the case for those subjects with IFG, compared to subjects with IGT or IFG+IGT mix, respectively. This effect was diluted at Year 3 and not observed. In conclusion, this study demonstrated that CGM did not predict progression from pre diabetes to diabetes (T2DM), but did however, correlate well by eye with mathematical assessments models of the same CGM data and identify an at risk IFG group that could be targeted at baseline with more intensive therapy.

Item Type:	Thesis (MD)
Date Type:	Publication
Status:	Unpublished
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General)
Date of First Compliant Deposit:	9 November 2016
Last Modified:	04 Jun 2017 09:30
URI:	https://orca.cardiff.ac.uk/id/eprint/95959

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