Diabetologia. 2026 Oct 07.
AIMS/HYPOTHESIS: Monitoring of beta cell function in individuals with islet autoimmunity who do not require insulin treatment (preclinical type 1 diabetes) is normally done via OGTTs, posing major challenges given the invasiveness of the test. Here, we validated a disposition index (DI) derived from continuous glucose monitoring (CGM) metrics (DICGM), which is a proxy of beta cell function, against the gold-standard OGTT DI (DIMM), in a cohort of individuals with one or more islet autoantibodies who do not require insulin treatment.
METHODS: Participants underwent a 3 h 10-point OGTT with measurement of glucose, insulin and C-peptide while wearing a blinded CGM. The sensor was started 24 h prior to the OGTT. DICGM was computed using CGM data during the 3 h OGTT and two blood glucose calibrations, and compared with the DI from the oral minimal model (DIMM), which uses plasma glucose, insulin and C-peptide. The association between the baseline DICGM and duration of glucose levels above 7.8 mmol/l (140 mg/dl) (TA140) at 1 year was explored.
RESULTS: Twenty-four participants (median age 16.8 years [IQR 13.5-27.7] ) were enrolled, of whom 18 completed both the OGTT (ten with pre-stage 1, seven with stage 1 and one with stage 3a type 1 diabetes) and CGM at baseline, and had repeat CGM 1 year later. The baseline DICGM was highly correlated with the DIMM (r=0.90, p<0.001). Lower baseline DICGM was associated with higher 1 year TA140 (r=-0.61, p=0.014) and higher 1 year mean sensor glucose (r=-0.62, p=0.020).
CONCLUSIONS/INTERPRETATION: Beta cell function can be estimated using CGM during a glucose load. DICGM correlates with a 1 year clinically relevant outcome (TA140) in individuals with islet autoimmunity who do not require insulin therapy.
Keywords: Beta cell function; CGM; Continuous glucose monitoring; Digital biomarkers; Model identification; Preclinical T1D; Stage 1 T1D; Stage 2 T1D; Type 1 diabetes