Tight glycemic control reduces vascular complications but fails to preserve beta cell function in pediatric type 1 diabetes: JAMA

The study included youths with newly diagnosed type 1 diabetes aged 7 to 17 years randomized from 2020 to 2021 and completed their follow-up on September 15, 2022. Sixty-one were randomly assigned to intensive diabetes management, including the use of an automated insulin delivery system, or 52 to standard care, including the use of a continuous glucose monitor, as part of a factorial design in which people weighing 30 kg or more were also assigned to receive either oral verapamil or placebo.

A mixed-meal tolerance test–stimulated C-peptide area under the curve (a measure of pancreatic cell function) was determined 52 weeks from diagnosis (primary outcome).

The study revealed the following findings:

• Among 113 participants (mean age, 11.8 years; 43% were females; mean time from diagnosis to randomization, 24 days), 96% completed the trial.
• In the intensive management group, there was a decrease in the mean C-peptide area under the curve from 0.57 pmol/mL at baseline to 0.45 pmol/mL at 52 weeks, and in the standard care group, it decreased from 0.60 to 0.50 pmol/mL (treatment group difference, −0.01).
• In the intensive management group, the mean time in the target range of 70 to 180 mg/dL, measured with continuous glucose monitoring, was 78% at 52 weeks versus 64% in the standard care group (adjusted difference, 16%).
• One severe hypoglycemia event and one diabetic ketoacidosis event occurred in each group.

"Intensive diabetes management in youth with newly diagnosed type 1 diabetes achieved excellent glucose control but did not impact the decline in pancreatic C-peptide secretion at 52 weeks," the team concluded.

Reference:

McVean J, Forlenza GP, Beck RW, et al. Effect of Tight Glycemic Control on Pancreatic Beta Cell Function in Newly Diagnosed Pediatric Type 1 Diabetes: A Randomized Clinical Trial. JAMA. Published online February 24, 2023. doi:10.1001/jama.2023.2063