Glycaemic Variability and C-Peptide in Bangladeshi Children, Adolescents, and Young Adults With Diabetes: A Prospective Study

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism Pub Date : 2026-10-04 DOI:10.1002/edm2.70347

Ajmina Hasan Flabe, Bedowra Zabeen, Shatil Amirat, Jing Luo

{"title":"Glycaemic Variability and C-Peptide in Bangladeshi Children, Adolescents, and Young Adults With Diabetes: A Prospective Study","authors":"Ajmina Hasan Flabe, Bedowra Zabeen, Shatil Amirat, Jing Luo","doi":"10.1002/edm2.70347","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To characterise the magnitude of glycaemic variability and to examine the factors associated with it, with particular attention to residual beta-cell function measured by fasting C-peptide, in children, adolescents, and young adults with diabetes in Bangladesh.</p>\n </section>\n \n <section>\n \n <h3> Design and Setting</h3>\n \n <p>Prospective observational study at the BADAS Paediatric Diabetes Care and Research Centre, BIRDEM, Dhaka, using 14 days of blinded professional continuous glucose monitoring (CGM). Participants were enrolled between March and November 2024.</p>\n </section>\n \n <section>\n \n <h3> Participants</h3>\n \n <p>Ninety-seven participants aged 1–25 years (68 with Type 1 and 29 with Type 2 diabetes) had at least seven valid CGM days and a paired HbA1c within 2 weeks of CGM initiation. Fasting C-peptide was available for 46 participants.</p>\n </section>\n \n <section>\n \n <h3> Main Outcome Measures</h3>\n \n <p>The coefficient of variation (CV) of glucose as the primary metric of variability; time in range, time above range, and time below range as secondary metrics; and independent predictors of CV on multivariable regression.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Mean CV was 39.4% (SD 9.2), and 59 of 97 participants (60.8%) were at or above the recommended target of 36%. CV was higher in Type 1 than Type 2 diabetes (41.9% vs. 33.3%). Lower fasting C-peptide was independently associated with higher CV after adjustment for diabetes type, age, and insulin dose (−1.94 percentage points per ng/mL, 95% CI −3.35 to −0.53; model R-squared 0.52), with a graded relationship across pre-specified C-peptide categories for CV, time in range, and time below range.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Glycaemic variability substantially exceeds international targets in this setting. Fasting C-peptide, available for fewer than half of the cohort, showed a graded association with variability that is best regarded as hypothesis-generating; if confirmed in larger studies, it could offer a low-cost means of identifying children at highest variability risk where CGM access is limited.</p>\n </section>\n </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 6","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635488/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrinology, Diabetes and Metabolism","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/edm2.70347","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

To characterise the magnitude of glycaemic variability and to examine the factors associated with it, with particular attention to residual beta-cell function measured by fasting C-peptide, in children, adolescents, and young adults with diabetes in Bangladesh.

Design and Setting

Prospective observational study at the BADAS Paediatric Diabetes Care and Research Centre, BIRDEM, Dhaka, using 14 days of blinded professional continuous glucose monitoring (CGM). Participants were enrolled between March and November 2024.

Participants

Ninety-seven participants aged 1–25 years (68 with Type 1 and 29 with Type 2 diabetes) had at least seven valid CGM days and a paired HbA1c within 2 weeks of CGM initiation. Fasting C-peptide was available for 46 participants.

Main Outcome Measures

The coefficient of variation (CV) of glucose as the primary metric of variability; time in range, time above range, and time below range as secondary metrics; and independent predictors of CV on multivariable regression.

Results

Mean CV was 39.4% (SD 9.2), and 59 of 97 participants (60.8%) were at or above the recommended target of 36%. CV was higher in Type 1 than Type 2 diabetes (41.9% vs. 33.3%). Lower fasting C-peptide was independently associated with higher CV after adjustment for diabetes type, age, and insulin dose (−1.94 percentage points per ng/mL, 95% CI −3.35 to −0.53; model R-squared 0.52), with a graded relationship across pre-specified C-peptide categories for CV, time in range, and time below range.

Conclusions

Glycaemic variability substantially exceeds international targets in this setting. Fasting C-peptide, available for fewer than half of the cohort, showed a graded association with variability that is best regarded as hypothesis-generating; if confirmed in larger studies, it could offer a low-cost means of identifying children at highest variability risk where CGM access is limited.

查看原文本刊更多论文

孟加拉国儿童、青少年和青年糖尿病患者的血糖变异性和c肽：一项前瞻性研究。

目的：在孟加拉国患有糖尿病的儿童、青少年和年轻人中，描述血糖变异性的大小，并检查与之相关的因素，特别关注通过禁食c肽测量的剩余β细胞功能。设计和设置：前瞻性观察研究在达卡BIRDEM的BADAS儿童糖尿病护理和研究中心进行，采用14天的盲法专业连续血糖监测（CGM）。参与者是在2024年3月至11月间注册的。参与者：97名年龄在1-25岁的参与者（68名1型糖尿病患者和29名2型糖尿病患者）在CGM开始的2周内至少有7天有效的CGM和配对的HbA1c。46名受试者可获得空腹c肽。主要结局指标：以葡萄糖的变异系数（CV）作为可变性的主要指标；范围内时间、范围以上时间和范围以下时间作为次要指标；多变量回归CV的独立预测因子。结果：平均CV为39.4% (SD 9.2)， 97名参与者中有59名（60.8%）达到或高于推荐目标36%。1型糖尿病的CV高于2型糖尿病（41.9% vs. 33.3%）。在调整糖尿病类型、年龄和胰岛素剂量后，较低的空腹c肽与较高的CV独立相关（每ng/mL -1.94个百分点，95% CI -3.35至-0.53；模型r平方0.52），在预先指定的c肽类别中，CV、在范围内时间和低于范围的时间呈分级关系。结论：在这种情况下，血糖变异性大大超过了国际目标。空腹c肽，可用于不到一半的队列，显示出与变异性的分级关联，最好被认为是假设产生；如果在更大规模的研究中得到证实，它可以提供一种低成本的方法来识别具有最高变异风险的儿童，这些儿童获得CGM的机会有限。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊