1. bookVolume 26 (2018): Issue 3 (July 2018)
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

Increased glycemic variability in type 2 diabetes patients treated with insulin - a real-life clinical practice, continuous glucose monitoring (CGM) study

Published Online: 31 Jul 2018
Page range: 345 - 352
Received: 28 Dec 2017
Accepted: 15 Feb 2018
Journal Details
License
Format
Journal
eISSN
2284-5623
First Published
08 Aug 2013
Publication timeframe
4 times per year
Languages
English
Abstract

Chronic hyperglycemia is an important cause for the development of chronic complications of diabetes, but glycemic variability has emerged in recent years as an independent contributor to diabetes-related complications. Our objective was to evaluate glycemic variability in patients with T2DM treated with insulin compared with other antidiabetic drugs. In this retrospective study, we collected 24-hour continuous glucose monitoring (CGM) recording data from 95 patients with T2DM, of which 27 treated with insulin and 68 with non-insulin treatment. We calculated and compared 16 glucose variability parameters in the insulin-treated and non-insulin treated groups. Insulin treated patients had significantly higher values of parameters describing the amplitude of glucose value fluctuations (standard deviation of glucose values, percentage coefficient of variation [%CV], and mean amplitude of glycemic excursion [MAGE], p <0.05) and time-dependent glucose variability (percentage of time with glycemic values below 70 mg/dl and continuous overall net glycemic action [CONGA] at 2, 4 and 6 hours, p <0.05). In conclusion, insulin therapy in T2DM is correlated with significantly higher glycemic variability.

Keywords

1. International Diabetes Federation. IDF Diabetes, 8 ed. Brussels, Belgium. International Diabetes Federation, 2017. https://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html. Accesed on 04th of February 2018.Search in Google Scholar

2. WHO. 10 facts on diabetes. April 2016. http://www.who.int/features/factfiles/diabetes/en/ Accessed on 28th of December 2016.Search in Google Scholar

3. American Diabetes Association. Standards of Medical Care. Diabetes Care. 2016;39 (Suppl 1): S1-112.Search in Google Scholar

4. 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

5. 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: 10.1186/1758-5996-6-13910.1186/1758-5996-6-139Open DOISearch in Google Scholar

6. 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.2014.06.007Open DOISearch in Google Scholar

7. 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.96.6.1750Open DOISearch in Google Scholar

8. Monnier L, Colette C, Owens DR. Glycemic Variability: The Third Component of the Dysglycemia in Diabetes. Is It Important? How to Measure It? J Diabetes Sci Technol. 2008 Nov;2(6):1094–100. DOI: 10.1177/19322968080020061810.1177/193229680800200618Search in Google Scholar

9. American Diabetes Association. Standards of Medical Care for Patients With Diabetes Mellitus. Diabetes Care 2002; 25(suppl 1): s33-s49. DOI: 10.2337/diacare.25.2007.S3310.2337/diacare.25.2007.S33Open DOISearch in Google Scholar

10. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-53. DOI: 10.1016/S0140-6736(98)07019-610.1016/S0140-6736(98)07019-6Search in Google Scholar

11. 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: 10.1177/19322968110050023610.1177/193229681100500236312594121527118Open DOISearch in Google Scholar

12. 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: 10.4103/2230-8210.12355610.4103/2230-8210.123556404659224910827Open DOISearch in Google Scholar

13. Ramchandani N. Continuous Glucose Monitoring. Troubleshooting Common Problems. Published May 3, 2012. http://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/continuous-glucose-monitoring/ Accessed on 14th of December 2017.Search in Google Scholar

14. Kilpatrick ES, Rigby AS, Atkin SL. The effect of glucose variability on the risk of microvascular complications in type 1 diabetes. Diabetes Care. 2006;29(7):1486–1490. DOI: 10.2337/dc06-029310.2337/dc06-029316801566Open DOISearch in Google Scholar

15. DeVries JH. Glucose variability: where it is important and how to measure it. Diabetes. 2013;62(5):1405–8. DOI: 10.2337/db12-161010.2337/db12-1610363664323613566Search in Google Scholar

16. Wójcicki JM. Mathematical descriptions of the glucose control in diabetes therapy. Analysis of the Schlichtkrull “M”-value. Horm Metab Res. 1995;27(1):1–5. DOI: 10.1055/s-2007-97989510.1055/s-2007-9798957729784Open DOISearch in Google Scholar

17. Wójcicki JM. “J”-index. A new proposition of the assessment of current glucose control in diabetic patients. Horm Metab Res. 1995;27(1):41–2. DOI: 10.1055/s-2007-97990610.1055/s-2007-9799067729793Open DOISearch in Google Scholar

18. Service FJ, Molnar GD, Rosevear JW, Ackerman E, Gatewood LC, Taylor WF. Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes. 1970;19(9):644–55. DOI: 10.2337/diab.19.9.64410.2337/diab.19.9.6445469118Open DOISearch in Google Scholar

19. 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.2005.7.25315857227Open DOISearch in Google Scholar

20. Inbody 720 User’s Manual. 1996-2004 Biospace Co, Ltd.; Available at: http://www.bodyanalyse.no/docs/720%20users%20manual.pdf.Search in Google Scholar

21. Jellinger P, Davidson J, Blonde L, Einhorn D, Grunberger G, Handelsman Y et al. Road Maps to Achieve Glycemic Control in Type 2 Diabetes Mellitus: ACE/AACE Diabetes Road Map Task Force. Endocrine Practice. 2007;13(3):260-8. DOI: 10.4158/EP.13.3.26010.4158/EP.13.3.26017599857Search in Google Scholar

22. American Diabetes Association. Standards of Medical Care. Diabetes Care. 2017;40(Suppl 1):S64-74.10.2337/dc17-S01127979895Search in Google Scholar

23. Amiel SA, Dixon T, Mann R, Jameson K. Hypoglycemia in Type 2 diabetes. Diabet Med. 2008;25(3):245–54. DOI: 10.1111/j.1464-5491.2007.02341.x10.1111/j.1464-5491.2007.02341.x232722118215172Open DOISearch in Google Scholar

24. Hanefeld M, Frier BM, Pistrosch F. Hypoglycemia and Cardiovascular Risk: Is There a Major Link? Diabetes Care. 2016;39(Suppl.2):S205-9. DOI: 10.2337/dcS15-301410.2337/dcS15-301427440834Open DOISearch in Google Scholar

25. Takeishi S, Mori A, Hachiya H, Yumura T, Ito S, Shibuya T et al. Hypoglycemia and glycemic variability are associated with mortality in non-intensive care unit hospitalized infectious disease patients with diabetes mellitus. J Diabetes Investig 2016;7(3):429–35. DOI: 10.1111/jdi.1243610.1111/jdi.12436484789927330731Open DOISearch in Google Scholar

26. Tricco AC, Ashoor HM, Soobiah C, Hemmelgarn B, Moher D, Hutton B et al. Safety, effectiveness, and cost of long-acting versus intermediate-acting insulin for type 1 diabetes: protocol for a systematic review and network meta-analysis. Syst Rev 2013;2:73. DOI: 10.1186/2046-4053-2-7310.1186/2046-4053-2-73384712724020869Open DOISearch in Google Scholar

27. Bajaj HS, Venn K, Ye C, Patrick A, Kalra S, Khandwala H et al. Lowest Glucose Variability and Hypoglycemia Are Observed With the Combination of a GLP-1 Receptor Agonist and Basal Insulin (VARIATION Study). Diabetes Care. 2017;40(2):194-200. DOI: 10.2337/dc16-158210.2337/dc16-158227913575Open DOISearch in Google Scholar

28. Suh S, Kim JH. Glycemic Variability: How Do We Measure It and Why Is It Important? Diabetes Metab J. 2015;39(4):273–82. DOI: 10.4093/dmj.2015.39.4.27310.4093/dmj.2015.39.4.273454319026301188Open DOISearch in Google Scholar

29. Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol JP, et al. 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.295.14.168116609090Open DOISearch in Google Scholar

30. The FLAT-SUGAR Trial Investigators. Glucose Variability in a 26-Week Randomized Comparison of Mealtime Treatment With Rapid-Acting Insulin Versus GLP-1 Agonist in Participants With Type 2 Diabetes at High Cardiovascular Risk. Diabetes Care 2016 Jun;39(6):973-81. DOI: 10.2337/dc15-278210.2337/dc15-278227208320Open DOISearch in Google Scholar

31. Kovatchev B, Cobelli C. Glucose Variability: Timing, Risk Analysis, and Relationship to Hypoglycemia in Diabetes. Diabetes Care. 2016; 39(4): 502-10. DOI: 10.2337/dc15-203510.2337/dc15-2035480677427208366Search in Google Scholar

32. Fabris C, Facchinetti A, Fico G, Sambo F, Arredondo MT, Cobelli C; MOSAIC EU Project Consortium. Parsimonious Description of Glucose Variability in Type 2 Diabetes by Sparse Principal Component Analysis. J Diabetes Sci Technol. 2015;10(1):119-24. DOI: 10.1177/193229681559617310.1177/1932296815596173473820826232371Open DOISearch in Google Scholar

33. Monnier L, Colette C, Wojtusciszyn A, Dejager S, Renard E, Molinari N et al. Toward Defining the Threshold Between Low and High Glucose Variability in Diabetes. Diabetes Care. 2017;40(7):832-8. DOI: 10.2337/dc16-176910.2337/dc16-176928039172Open DOISearch in Google Scholar

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