Guy S Taylor, Bram Burger, Jadine H Scragg, Ollie Page, Henry Schmid, Jeremie Nsengimana, Daniel J West, James A M Shaw
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Mixed-effects linear regression, fitted with a random effect for individuals and fixed effects for age at diagnosis groups, insulin delivery modality, and duration of diabetes, was used to analyze percentage time in different glycemic states over 24 h, during sleep/exercise, and for the 2 h post-prandially. <b><i>Results:</i></b> Participants using hybrid closed-loop systems spent more time in range (TIR: 70-180 mg/dL) than those using continuous subcutaneous insulin infusion alone (<i>P</i> < 0.001) or multiple daily injections (<i>P</i> < 0.001). TIR correlated positively with age at diagnosis and increased incrementally between diagnostic age groups overall (mean ± standard deviation, AgeDx<sup><7</sup>: 71.4 ± 16.0%, AgeDx<sup>13-30</sup>: 73.0 ± 13.9%; AgeDx<sup>>30</sup> 78.3 ± 14.1%), during exercise, while sleeping and post-prandially. Linear effects modeling confirmed higher TIR in AgeDx<sup>>30</sup> compared with AgeDx<sup><7</sup> overall (12.3%, 95% confidence interval [CI] 4.9%-19.8%, <i>P</i> = 0.0002), during exercise (13.7%, 95% CI 5.3%-22.0%, <i>P</i> = 0.0002), while sleeping (11.0%, 95% CI 3.5%-17.0%, <i>P</i> = 0.0043) and post-prandially (14.9%, 95%CI 5.9 to 23.9%, <i>P</i> = 0.0001). AgeDx<sup>13-30</sup> spent more TIR than AgeDx<sup><7</sup> during exercise (8.3%, 95% CI 1.9%-14.7%, <i>P</i> = 0.0050). <b><i>Conclusions:</i></b> In addition to insulin modality, age at type 1 diabetes diagnosis independently impacts on glycemia in adults and should be factored into personalized care planning.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3000,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Age at Diagnosis and Insulin Delivery Modality on Free-Living Glycemia in Type 1 Diabetes During Periods Associated with Dysglycemia: A Retrospective Analysis of the Type 1 Diabetes EXercise Initiative Study.\",\"authors\":\"Guy S Taylor, Bram Burger, Jadine H Scragg, Ollie Page, Henry Schmid, Jeremie Nsengimana, Daniel J West, James A M Shaw\",\"doi\":\"10.1177/15209156251370942\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Objective:</i></b> To determine the impact of age at diagnosis and insulin delivery modality on free-living glycemia in type 1 diabetes overall and during common periods of dysglycemia (sleep, post-prandially, exercise). <b><i>Research Design and Methods:</i></b> Retrospective analysis of 4 weeks' free-living data from 423 people with type 1 diabetes duration >5 years within the T1DEXI Study. Participants were divided into putative age at diagnosis endotype groups: AgeDx<sup><7</sup> (diagnosed <7 years old); AgeDx<sup>7-12</sup> (7-12 years); AgeDx<sup>13-30</sup> (13-30 years); and AgeDx<sup>>30</sup> (>30 years). Mixed-effects linear regression, fitted with a random effect for individuals and fixed effects for age at diagnosis groups, insulin delivery modality, and duration of diabetes, was used to analyze percentage time in different glycemic states over 24 h, during sleep/exercise, and for the 2 h post-prandially. <b><i>Results:</i></b> Participants using hybrid closed-loop systems spent more time in range (TIR: 70-180 mg/dL) than those using continuous subcutaneous insulin infusion alone (<i>P</i> < 0.001) or multiple daily injections (<i>P</i> < 0.001). TIR correlated positively with age at diagnosis and increased incrementally between diagnostic age groups overall (mean ± standard deviation, AgeDx<sup><7</sup>: 71.4 ± 16.0%, AgeDx<sup>13-30</sup>: 73.0 ± 13.9%; AgeDx<sup>>30</sup> 78.3 ± 14.1%), during exercise, while sleeping and post-prandially. Linear effects modeling confirmed higher TIR in AgeDx<sup>>30</sup> compared with AgeDx<sup><7</sup> overall (12.3%, 95% confidence interval [CI] 4.9%-19.8%, <i>P</i> = 0.0002), during exercise (13.7%, 95% CI 5.3%-22.0%, <i>P</i> = 0.0002), while sleeping (11.0%, 95% CI 3.5%-17.0%, <i>P</i> = 0.0043) and post-prandially (14.9%, 95%CI 5.9 to 23.9%, <i>P</i> = 0.0001). AgeDx<sup>13-30</sup> spent more TIR than AgeDx<sup><7</sup> during exercise (8.3%, 95% CI 1.9%-14.7%, <i>P</i> = 0.0050). <b><i>Conclusions:</i></b> In addition to insulin modality, age at type 1 diabetes diagnosis independently impacts on glycemia in adults and should be factored into personalized care planning.</p>\",\"PeriodicalId\":11159,\"journal\":{\"name\":\"Diabetes technology & therapeutics\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.3000,\"publicationDate\":\"2025-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diabetes technology & therapeutics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/15209156251370942\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes technology & therapeutics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/15209156251370942","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
摘要
目的：确定诊断年龄和胰岛素输送方式对1型糖尿病患者总体和常见血糖异常时期（睡眠、餐后、运动）自由生活血糖的影响。研究设计和方法：回顾性分析T1DEXI研究中423例1型糖尿病患者4周的自由生活数据。参与者被分为诊断时的假定年龄组：AgeDx（诊断为7-12岁）；AgeDx13-30（13-30岁）；和AgeDx bbbb30 （bbbb30年）。采用混合效应线性回归，拟合个体随机效应和诊断组年龄、胰岛素给药方式和糖尿病病程的固定效应，分析24小时内、睡眠/运动期间和餐后2小时内不同血糖状态的时间百分比。结果：使用混合闭环系统的参与者比单独使用连续皮下胰岛素输注（P < 0.001）或多次每日注射（P < 0.001）的参与者在范围内（TIR: 70-180 mg/dL）花费更多的时间。在运动、睡眠和餐后，TIR与诊断年龄呈正相关，在各诊断年龄组之间总体呈递增趋势（平均值±标准差，AgeDx: 71.4±16.0%,AgeDx13-30: 73.0±13.9%,AgeDx bbb30 78.3±14.1%）。线性效应模型证实，与AgeDx总体相比，AgeDx bb30的TIR更高（12.3%，95%可信区间[CI] 4.9%-19.8%, P = 0.0002），运动期间（13.7%,95%CI 5.3%-22.0%, P = 0.0002），睡眠期间（11.0%,95%CI 3.5%-17.0%, P = 0.0043）和餐后（14.9%,95%CI 5.9 - 23.9%, P = 0.0001）。AgeDx13-30在运动中比AgeDx消耗更多的TIR （8.3%, 95% CI 1.9%-14.7%, P = 0.0050）。结论：除胰岛素方式外，1型糖尿病诊断年龄对成人血糖也有独立影响，应纳入个性化护理计划。
Impact of Age at Diagnosis and Insulin Delivery Modality on Free-Living Glycemia in Type 1 Diabetes During Periods Associated with Dysglycemia: A Retrospective Analysis of the Type 1 Diabetes EXercise Initiative Study.
Objective: To determine the impact of age at diagnosis and insulin delivery modality on free-living glycemia in type 1 diabetes overall and during common periods of dysglycemia (sleep, post-prandially, exercise). Research Design and Methods: Retrospective analysis of 4 weeks' free-living data from 423 people with type 1 diabetes duration >5 years within the T1DEXI Study. Participants were divided into putative age at diagnosis endotype groups: AgeDx<7 (diagnosed <7 years old); AgeDx7-12 (7-12 years); AgeDx13-30 (13-30 years); and AgeDx>30 (>30 years). Mixed-effects linear regression, fitted with a random effect for individuals and fixed effects for age at diagnosis groups, insulin delivery modality, and duration of diabetes, was used to analyze percentage time in different glycemic states over 24 h, during sleep/exercise, and for the 2 h post-prandially. Results: Participants using hybrid closed-loop systems spent more time in range (TIR: 70-180 mg/dL) than those using continuous subcutaneous insulin infusion alone (P < 0.001) or multiple daily injections (P < 0.001). TIR correlated positively with age at diagnosis and increased incrementally between diagnostic age groups overall (mean ± standard deviation, AgeDx<7: 71.4 ± 16.0%, AgeDx13-30: 73.0 ± 13.9%; AgeDx>30 78.3 ± 14.1%), during exercise, while sleeping and post-prandially. Linear effects modeling confirmed higher TIR in AgeDx>30 compared with AgeDx<7 overall (12.3%, 95% confidence interval [CI] 4.9%-19.8%, P = 0.0002), during exercise (13.7%, 95% CI 5.3%-22.0%, P = 0.0002), while sleeping (11.0%, 95% CI 3.5%-17.0%, P = 0.0043) and post-prandially (14.9%, 95%CI 5.9 to 23.9%, P = 0.0001). AgeDx13-30 spent more TIR than AgeDx<7 during exercise (8.3%, 95% CI 1.9%-14.7%, P = 0.0050). Conclusions: In addition to insulin modality, age at type 1 diabetes diagnosis independently impacts on glycemia in adults and should be factored into personalized care planning.
期刊介绍：
Diabetes Technology & Therapeutics is the only peer-reviewed journal providing healthcare professionals with information on new devices, drugs, drug delivery systems, and software for managing patients with diabetes. This leading international journal delivers practical information and comprehensive coverage of cutting-edge technologies and therapeutics in the field, and each issue highlights new pharmacological and device developments to optimize patient care.
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