SAT-529 - Continuous Glucose Monitors Detect Hyperglycemia in Males with Duchenne Muscular Dystrophy

Introduction/

Objective: Duchenne muscular dystrophy (DMD) is an X-linked disorder leading to muscle wasting, cardiopulmonary failure, and premature death. Individuals with DMD have multiple risk factors for hyperglycemia including long-term use of glucocorticoids, sarcopenia, obesity, and reduced ambulation. Despite these risks, diabetes is rarely reported in individuals with DMD and hemoglobin A1c (HbA1c) levels are often normal. The objective of this study was to evaluate glycemia in individuals with DMD using continuous glucose monitors (CGMs).

Methods: Observational study of males (10 years or older) with DMD (NCT06124196). CGMs (Dexcom Pro, Dexcom Inc) were placed on participants' abdomens during clinic visits or over secure video call with study staff. Glucose data was collected every 5 minutes for up to 10 days. The primary outcome was percent hyperglycemia (number of CGM glucose levels >140mg/dL over number of total glucose levels).

Results: Forty males with DMD enrolled and wore CGMs. Two participants were excluded due to having less than 1 day of data. One participant was excluded due to unexplained, severe, false hyperglycemia on CGM. On average participants were 16 years (IQR 12, 22). Adults (n=15) had an average BMI of 23.2 kg/m2 (IQR 17.8, 28.3; range 14.2-41.2) while children (n=22) had an average BMI z-score of 1.60 (IQR 1.15, 1.97; range -6.3-3.98).

The average length of CGM wear was 9.8 days (IQR 9.7, 9.9). Median of individuals’ mean glucose was 116.4mg/dL (IQR 101.2, 130.5) with COV 19.3% (IQR 16.5, 23.6). The median percent hyperglycemia over 140mg/dL was 14.7% (IQR 5.5, 26.8; range: 0.14-62.8) and over 199mg/dL was 0.33% (IQR 0, 1.5; range: 0-12.3). Twenty-three participants (62%) had at least 10% of their glucose levels >140mg/dL and 11 (30%) had at least 1% of glucose levels >199mg/dL. Despite this, HbA1c levels, when available, were generally normal.

Conclusion: In individuals with DMD, there is more hyperglycemia than expected on CGM, particularly in the setting of normal HbA1c levels. Remote CGM placement is feasible and may detect unknown hyperglycemia in males with DMD. Ongoing studies are evaluating CGM data in those with DMD compared to matched controls and the relationship between hyperglycemia, activity, sleep, and heart rate variability in individuals with DMD. Further studies are needed to confirm accuracy of CGM findings and to investigate why HbA1c levels may be less accurate.

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