1. bookVolume 24 (2016): Issue 1 (March 2016)
Journal Details
License
Format
Journal
eISSN
2284-5623
First Published
08 Aug 2013
Publication timeframe
4 times per year
Languages
English
access type Open Access

The correlation of dawn phenomenon with glycemic variability parameters in type 2 diabetes mellitus

Published Online: 19 Mar 2016
Page range: 55 - 64
Received: 08 Oct 2015
Accepted: 06 Jan 2016
Journal Details
License
Format
Journal
eISSN
2284-5623
First Published
08 Aug 2013
Publication timeframe
4 times per year
Languages
English
Abstract

Introduction. Dawn phenomenon could have deleterious effect on overall glycemic control. Glycemic variability may be an independent risk factor for the development of diabetes chronic complications. The study aimed to evaluate any correlations between the dawn phenomenon and parameters of glycemic variability in a cohort of type 2 diabetes patients (T2DM). Material and methods. This retrospective observational study included 131 T2DM patients. Continuous glucose monitoring (CGM) has been performed. Data from the first 24h of full recording were used for analysis of glycemic variability indices: mean level of 24h interstitial glucose value and standard deviation; % coefficient of variation; J index; mean amplitude of glycemic excursion - MAGE; continuous overall net glycemic action (CONGA) at 1, 2, 4 and 6 hours; mean of daily differences (MODD) index. Results. Mean age was 56.04 ± 9.91 years, 35.9% women, 17.6% on diet, 53.4% on oral therapy and 29% on insulin. Dawn phenomenon was more frequent in patients below 60 years (70%) and in oral therapy group (72.85%). Significant correlations between the dawn phenomenon and j-index, MAGE, CONGA-4 and CONGA-6 have been found in T2DM patients on diet therapy alone. The amplitude of dawn phenomenon was 46.10 ± 24.40 mg/dl and significantly correlated (p<0.05) after adjustment for age, gender and treatment with % CV, MAGE, CONGA-1, CONGA-2, CONGA-4, CONGA-6 and MODD. Conclusions. The dawn phenomenon significantly increases the glycemic variability parameters in drug-naive T2DM patients, with no impact in T2DM on oral or insulin therapy.

Keywords

1. Bright GM, Melton TW, Rogol AD, Clarke WL. Failure of cortisol blockade to inhibit early morning increases in basal insulin requirements in fasting insulin-dependent diabetics. Diabetes 1980; 29(8):662-4. DOI: 10.2337/diab.29.8.66210.2337/diab.29.8.662Search in Google Scholar

2. Bolli GB, Gerich JE. The “dawn-phenomenon” a common occurrence in both non-insulindependent and insulin-dependent diabetes mellitus. N Engl J Med. 1984; 310(12):746–50. DOI: 10.1056/NEJM19840322310120310.1056/NEJM198403223101203Search in Google Scholar

3. Shih KC, Hsieh SH, Kwok CF, Hwu CM, Hsieh PS, Ho LT. Effect of growth hormone on dawn phenomenon in patients with type 2 diabetes Growth Factors. 2013;31(2):66-73. DOI: 10.3109/08977194.2013.77299610.3109/08977194.2013.772996Search in Google Scholar

4. Carroll MF, Schade DS. The dawn phenomenon revisited: implications for diabetes therapy. Endocr Pract. 2005;11(1):55–64. DOI: 10.4158/EP.11.1.5510.4158/EP.11.1.55Search in Google Scholar

5. Atiea JA, Luzio S, Owens DR. The dawn phenomenon and diabetes control in treated NIDDM and IDDM patients. Diabetes Res Clin Pract 1992;16(3):183–190. Carroll MF, Hardy KJ, Burge MR, Schade DS. Frequency of the dawn phenomenon in type 2 diabetes: implications for diabetes therapy. Diabetes Technol Ther. 2002;4(5):595–605. DOI: 10.1089/15209150232079821310.1089/152091502320798213Search in Google Scholar

6. Campbell PJ, Bolli GB, Cryer PE, Gerich JE. Pathogenesis of the dawn phenomenon in patients with insulin-dependent diabetes mellitus. Accelerated glucose production and impaired glucose utilization due to nocturnal surges in growth hormone secretion. N Engl J Med. 1985 Jun 6;312(23):1473-9. DOI: 10.1056/NEJM19850606312230210.1056/NEJM198506063122302Search in Google Scholar

7. Schmidt MI, Hadji-Georgopoulos A, Rendell M, Margolis S, Kowarski A. The dawn phenomenon, an early morning glucose rise: implications for diabetic intraday blood glucose variation. Diabetes Care. 1981;4(6):579–85. DOI: 10.2337/diacare.4.6.57910.2337/diacare.4.6.579Search in Google Scholar

8. D’Alessio D. The role of dysregulated glucagon secretion in type 2 diabetes. Diabetes Obes Metab. 2011 Oct;13 Suppl 1:126-32. DOI: 10.1111/j.1463-1326.2011.01449.x10.1111/j.1463-1326.2011.01449.xSearch in Google Scholar

9. Monnier L, Colette C, Dejager S, Owens D. Magnitude of the dawn phenomenon and its impact on the overall glucose exposure in type 2 diabetes: is this of concern? Diabetes Care. 2013;36(12):4057–62. DOI: 10.2337/dc12-212710.2337/dc12-2127Search in Google Scholar

10. Brownlee M, Hirsch IB. Glycemic variability: a hemoglobin A1c independent risk factor for diabetic complications. J Am Med Assoc. 2006;295(14):1707–8. DOI: 10.1001/jama.295.14.170710.1001/jama.295.14.1707Search in Google Scholar

11. Kilpatrick ES, Rigby AS, Atkin SL. The effect of glucose variability on the risk of microvascular complications in type 1 diabetes. Diabetes Care. 2009;32(10):1901-3. DOI: 10.2337/dc09-010910.2337/dc09-0109Search in Google Scholar

12. Frontoni S, Di Bartolo P, Avogaro A, Bosi E, Paolisso G, Ceriello A. Glucose variability: An emerging target for the treatment of diabetes mellitus. Diabetes Res Clin Pract. 2013;102(2):86-95. DOI: 10.1016/j.diabres.2013.09.00710.1016/j.diabres.2013.09.007Search in Google Scholar

13. Xu F, Zhao LH, Su JB, Chen T, Wang XQ, Chen JF, et al. The relationship between glycemic variability and diabetic peripheral neuropathy in type 2 diabetes with well-controlled HbA1c. Diabetol Metab Syndr. 2014;6(1):139. DOI: 10.1186/1758-5996-6-13910.1186/1758-5996-6-139Search in Google Scholar

14. Smith-Palmer J, Brändle M, Trevisan R, Orsini Federici M, Liabat S, Valentine W. Assessment of the association between glycemic variability and diabetes-related complications in type 1 and type 2 diabetes. Diabetes Res Clin Pract. 2014;105(3):273-84. DOI: 10.1016/j.diabres.2014.06.00710.1016/j.diabres.2014.06.007Search in Google Scholar

15. Muggeo M, Verlato G, Bonora E, Zoppini G, Corbellini M, de Marco R. Long-term instability of fasting plasma glucose, a novel predictor of cardiovascular mortality in elderly patients with non-insulin-dependent diabetes mellitus: the Verona Diabetes Study. Circulation. 1997;96(6):1750–4. DOI: 10.1161/01.CIR.96.6.175010.1161/01.CIR.96.6.1750Search in Google Scholar

16. Klonoff DC. Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care. 2005; 28(5):1231-39. DOI: 10.2337/diacare.28.5.123110.2337/diacare.28.5.1231Search in Google Scholar

17. Ward WK, Castle JR, Jacobs PG, Cargill RS. Can glucose be monitored accurately at the site of subcutaneous insulin delivery? J Diabetes Sci Technol. 2014;8(3):568-74. DOI: 10.1177/193229681452280510.1177/1932296814522805Search in Google Scholar

18. Czerwoniuk D, Fendler W, Walenciak L, Mlynarski W. GlyCulator: a glycemic variability calculation tool for continuous glucose monitoring data. J Diabetes Sci Technol. 2011; 5(2):447–51. DOI: 10.1177/19322968110050023610.1177/193229681100500236Search in Google Scholar

19. Khadilkar KS, Bandgar T, Shivane V, Lila A, Shah N. Current concepts in blood glucose monitoring. Indian J Endocrinol Metab. 2013;17(Suppl 3):S643–9. DOI: 10.4103/2230-8210.12355610.4103/2230-8210.123556Search in Google Scholar

20. Higuchi T. Approach to an irregular time series on the basis of the fractal theory. Physica D. 1988;31(2):277–83. DOI: 10.1016/0167-2789(88)90081-410.1016/0167-2789(88)90081-4Search in Google Scholar

21. Monnier L, Colette C, Dejager S, Owens D. The dawn phenomenon in type 2 diabetes: How to assess it in clinicalpractice? Diabetes Metab. 2015;41(2):132-7. DOI: 10.1016/j.diabet.2014.10.00210.1016/j.diabet.2014.10.002Search in Google Scholar

22. Directive 2001/20/CE of the European Parliament and of the council of 4April 2001 on the approximation of the laws, regulations and administrativeprovisions of the Member States relating to the implementation of goodclinical trials on medicinal products for human use. Off J Eur Communities. 2001;L121:33–44.Search in Google Scholar

23. Monnier L, Colette C, Sardinoux M, Baptista G, Regnier-Zerbib A, Owens D. Frequency and severity of the dawn phenomenon in type 2 diabetes: relationship to age. Diabetes Care. 2012;35(12):2597-9. DOI: 10.2337/dc12-038510.2337/dc12-0385Search in Google Scholar

24. Boden G, Chen X, Urbain JL. Evidence for a circadian rhythm of insulin sensitivity in patients with NIDDM caused by cyclic changes in hepatic glucose production. Diabetes. 1996;45(8):1044–50. DOI: 10.2337/diabetes.45.8.1044 DOI: 10.2337/diab.45.8.104410.2337/diabetes.45.8.1044Search in Google Scholar

25. Porcellati F, Lucidi P, Cioli P, Candeloro P, Marinelli Andreoli A, Marzotti S et al. Pharmacokinetics and pharmacodynamics of insulin glargine given in the evening as compared with in the morning in type 2 diabetes. Diabetes Care. 2015 Mar;38(3):503-12. DOI: 10.2337/dc14-064910.2337/dc14-0649Search in Google Scholar

26. Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol JP, Colette C. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295(14):1681-7. DOI: 10.1001/jama.295.14.168110.1001/jama.295.14.1681Search in Google Scholar

27. Wójcicki JM. “J”-index. A new proposition of the assessment of current glucose control in diabetic patients. Horm Metab Res. 1995;27(1):41–42. DOI: 10.1055/s-2007-97990610.1055/s-2007-979906Search in Google Scholar

28. McDonnell CM, Donath SM, Vidmar SI, Werther GA, Cameron FJ. A novel approach to continuous glucose analysis utilizing glycemic variation. Diabetes Technol Ther. 2005;7(2):253–63. DOI: 10.1089/dia.2005.7.25310.1089/dia.2005.7.253Search in Google Scholar

29. Molnar GD, Taylor WF, Ho MM. Day-to-day variation of continuously monitored glycaemia: a further measure of diabetic instability. Diabetologia. 1972;8(5):342–348. DOI: 10.1007/BF0121849510.1007/BF01218495Search in Google Scholar

Recommended articles from Trend MD

Plan your remote conference with Sciendo