Relationship between glycemic intraday variations evaluated in continuous glucose monitoring and HbA1c variability in type 2 diabetes: pilot study

Abstract Background HbA1c variability is independent of mean HbA1c, and associated with mortality due to vascular complications. However, the significance of HbA1c variability is unknown at present. In this study, we used flash glucose monitoring (FGM) and evaluated glycemic intraday variations, and then examined the association with HbA1c variability. Methods We conducted a retrospective pilot study of 26 patients treated at the Outpatient department for type 2 diabetes mellitus (T2DM), and evaluated the following items associated with blood glucose levels and their changes/variations using FGM. The primary endpoint was factor(s) associated with standard deviation (SD) HbA1c over a 6-month period. To adjust for the effect of varying numbers of HbA1c measurements, we used the adjusted SD of HbA1c. Results There were significant correlations between mean HbA1c and each of glucose management indicator, maximum, percent time at glucose > 180 mg/day, mean of daily difference of blood glucose, and high blood glucose index. Adjusted SD HbA1c correlated significantly with percent time at glucose < 70 mg/dL and low blood glucose index. We estimated the regression coefficient of adjusted SD HbA1c using multivariate linear regression analysis, and noted that the presence of hypoglycemia affected Adjusted SD HbA1c (β = 0.130, SE = 0.044, P = 0.008). Hypoglycemia was noted in 17 patients, and adjusted SD HbA1c was significantly higher (p = 0.001) in the hypoglycemic group (0.22 ± 0.12%), compared with the non-hypoglycemic group (0.08 ± 0.05%). The cut-off value of adjusted SD HbA1c was 0.109% in the hypoglycemic group. Conclusions The results showed that HbA1c variability is associated with hypoglycemia. For patients with high HbA1c variability, we recommend evaluation for the presence of hypoglycemia and reconsideration of their treatment regimen including their glucose-lowering medications. Trial registration The study protocol and opt-out method of informed consent were approved by the ethics committees of the University of Occupational and Environmental Health (Trial registration: H27-186, Registered 25 Dec 2015)

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Relationship Between Glycemic Intraday Variations Evaluated in Continuous Glucose Monitoring and HbA1c Variability in Type 2 Diabetes: Pilot Study

10.21203/rs.3.rs-168067/v1 ◽

2021 ◽

Author(s):

Akemi Tokutsu ◽

Yosuke Okada ◽

Keiichi Torimoto ◽

Yoshiya Tanaka

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Pilot Study ◽

Glucose Monitoring ◽

Trial Registration ◽

Multivariate Linear Regression Analysis ◽

High Blood Glucose ◽

Percent Time ◽

Hba1c Variability

Abstract Background: HbA1c variability is independent of mean HbA1c, and associated with mortality due to vascular complications. However, the significance of HbA1c variability is unknown at present. In this study, we used flash glucose monitoring (FGM) and evaluated glycemic intraday variations, and then examined the association with HbA1c variability.Methods: We conducted a retrospective pilot study of 26 patients treated at the Outpatient department for type 2 diabetes mellitus (T2DM), and evaluated the following items associated with blood glucose levels and their changes/variations using FGM. The primary endpoint was factor(s) associated with Standard deviation (SD) HbA1c over a six-month period. Results: There were significant correlations between mean HbA1c and each of glucose management indicator, maximum, percent time at glucose >180 mg/d, mean of daily difference of blood glucose, and high blood glucose index. SD HbA1c correlated significantly with percent time at glucose <70 mg/dL and low blood glucose index. We estimated the regression coefficient of SD HbA1c using multivariate linear regression analysis, and noted that the presence of hypoglycemia affected SD HbA1c (β=0.132, SE=0.055, P=0.026). Hypoglycemia was noted in 17 patients, and SD HbA1c was significantly higher (p<0.001) in the hypoglycemic group (0.24±0.13%), compared with the non-hypoglycemic group (0.09±0.06%). The cut-off value of SD HbA1c was 0.126% in the hypoglycemic group.Conclusions: The results showed that HbA1c variability is associated with hypoglycemia. HbA1c variability reflects the risk of hypoglycemia, suggesting a possible association with the risk of cardiovascular mortality. For patients with high HbA1c variability, we recommend evaluation for the presence of hypoglycemia and reconsideration of their treatment regimen including their glucose-lowering medications.Trial registration: The study protocol and opt-out method of informed consent were approved by the ethics committees of the University of Occupational and Environmental Health (Trial registration: H27-186, Registered 25 Dec 2015).

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The effect of brief intermittent stair climbing on glycemic control in people with type 2 diabetes: a pilot study

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2018-0135 ◽

2018 ◽

Vol 43 (9) ◽

pp. 969-972 ◽

Cited By ~ 5

Author(s):

F. Elizabeth Godkin ◽

Elizabeth M. Jenkins ◽

Jonathan P. Little ◽

Zafreen Nazarali ◽

Michael E. Percival ◽

...

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Pilot Study ◽

Glycemic Control ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Stair Climbing ◽

Men 2

We examined the effect of brief intermittent stair climbing exercise on glycemic control using continuous glucose monitoring in people with type 2 diabetes (n = 7, 5 men; 2 women; age, 21–70 years). The protocol involved three 60-s bouts of vigorously ascending and slowly descending a flight of stairs. Mean 24-h blood glucose was unchanged after an acute session (p = 0.43) and following 18 sessions over 6 weeks (p = 0.13). The protocol was well tolerated by participants but seemingly insufficient to alter glycemic control.

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941-P: Frequency of Blood Glucose Monitoring in Relation to Medical Cost and Glycemic Control in Hospitalized Patients with Type 2 Diabetes

Diabetes ◽

10.2337/db19-941-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 941-P

Author(s):

LEI ZHANG ◽

YAN GU ◽

YUXIU YANG ◽

NA WANG ◽

WEIGUO GAO ◽

...

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Glycemic Control ◽

Medical Cost ◽

Glucose Monitoring ◽

Hospitalized Patients ◽

Blood Glucose Monitoring

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973-P: The Feasibility of Continuous Glucose Monitoring in Youth with Type 2 Diabetes Mellitus: A Pilot Study

Diabetes ◽

10.2337/db19-973-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 973-P

Author(s):

ALLISON LAROCHE ◽

KRISTINA UTZSCHNEIDER ◽

CATHERINE PIHOKER

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Pilot Study ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring

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Real-time continuous glucose monitoring versus self-monitoring of blood glucose in adults with insulin-treated type 2 diabetes: a protocol for a randomised controlled single-centre trial

BMJ Open ◽

10.1136/bmjopen-2020-040648 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040648

Author(s):

Nanna Lind ◽

Dorte Lindqvist Hansen ◽

Signe Sætre Rasmussen ◽

Kirsten Nørgaard

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Peer Support ◽

Continuous Glucose Monitoring ◽

Data Protection ◽

Treatment Options ◽

Glucose Monitoring ◽

Single Centre ◽

Self Monitoring

IntroductionMedical treatment options for type 2 diabetes (T2D) have increased over the last decade and enhance the possibility of individualised treatment strategies where insulin is still one of them. In spite of the advancements in treatment options, less than one-third of the population with T2D obtain their optimal glycaemic goal. In persons with type 1 diabetes, continuous glucose monitoring (CGM) has shown to be the most important driver for improvement in glycaemic control, even more than insulin-pump therapy. The use of technology in T2D has only been investigated in few studies.The overall objective of the research study is to examine the effectiveness of the use of CGM versus self-monitoring of blood glucose (SMBG) in persons with insulin-treated T2D on glycaemic variables and patient-reported outcomes on treatment satisfaction, health behaviour and well-being. The independent effect of peer support will also be studied.Methods and analysisThe study is a single centre, prospective, randomised, open-labelled, three-armed study with the randomisation 2:1:2 in group A with CGM, group B with CGM and peer support, and group C as a control group with SMBG. The participants receive a training course unique for the allocation group. The study runs for 12 months and includes 100 adult participants with insulin-treated T2D, treated at the outpatient clinic at Steno Diabetes Center Copenhagen. Primary outcome is difference in change in time in range. Recruitment begins in August 2020 and ends in July 2021. Final 12-month follow-up is anticipated to be in August 2022.Ethics and disseminationThe study will be carried out in accordance with the Helsinki Declaration and is approved by the Scientific Ethics Committee of the Capital Region (H-20000843). Data collection and handling will be performed in accordance with the General Data Protection Regulation and is approved by the Danish Data Protection Agency (J-2020-100). Dissemination will be in international peer-reviewed journals, conferences and a plain-language summary for participants.Trial registration numberClinicalTrials.gov Registry (NCT04331444).Protocol versionV.3, 11 December 2020.

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Glycemic variability and cardiovascular disease in patients with type 2 diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002032 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002032

Author(s):

Marcela Martinez ◽

Jimena Santamarina ◽

Adrian Pavesi ◽

Carla Musso ◽

Guillermo E Umpierrez

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Glycated Hemoglobin ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Cardiovascular Complications ◽

Glucose Levels ◽

Increased Risk ◽

Patients With Diabetes

Glycated hemoglobin is currently the gold standard for assessment of long-term glycemic control and response to medical treatment in patients with diabetes. Glycated hemoglobin, however, does not address fluctuations in blood glucose. Glycemic variability (GV) refers to fluctuations in blood glucose levels. Recent clinical data indicate that GV is associated with increased risk of hypoglycemia, microvascular and macrovascular complications, and mortality in patients with diabetes, independently of glycated hemoglobin level. The use of continuous glucose monitoring devices has markedly improved the assessment of GV in clinical practice and facilitated the assessment of GV as well as hypoglycemia and hyperglycemia events in patients with diabetes. We review current concepts on the definition and assessment of GV and its association with cardiovascular complications in patients with type 2 diabetes.

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Patterns of blood glucose monitoring in relation to glycemic control among patients with type 2 diabetes in the UK

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2006.04.003 ◽

2007 ◽

Vol 21 (3) ◽

pp. 181-186 ◽

Cited By ~ 6

Author(s):

Kristina Secnik ◽

Nicole Yurgin ◽

Maureen J. Lage

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Glycemic Control ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

The Uk

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Breakfast replacement with a liquid formula improves glycaemic variability in patients with type 2 diabetes: a randomised clinical trial

British Journal Of Nutrition ◽

10.1017/s0007114518003628 ◽

2019 ◽

Vol 121 (5) ◽

pp. 560-566 ◽

Cited By ~ 4

Author(s):

Jiahui Peng ◽

Jingyi Lu ◽

Xiaojing Ma ◽

Lingwen Ying ◽

Wei Lu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Glucose Monitoring ◽

Mean Amplitude ◽

Randomised Clinical Trial ◽

Postprandial Blood Glucose ◽

Glycaemic Variability ◽

Intervention Measures ◽

Before And After

AbstractThere is emerging evidence that glycaemic variability (GV) plays an important role in the development of diabetic complications. The current study aimed to compare the effects of lifestyle intervention (LI) with and without partial meal replacement (MR) on GV. A total of 123 patients with newly diagnosed and untreated type 2 diabetes (T2D) were randomised to receive either LI together with breakfast replacement with a liquid formula (LI+MR) (n 62) or LI alone (n 61) for 4 weeks and completed the study. Each participant was instructed to have three main meals per d and underwent 72-h continuous glucose monitoring (CGM) both before and after intervention. Measures of GV assessed by CGM included the incremental AUC of postprandial blood glucose (AUCpp), standard deviation of blood glucose (SDBG), glucose CV and mean amplitude of glycaemic excursions (MAGE). After a 4-week intervention, the improvements in systolic blood pressure (P=0·046) and time in range (P=0·033) were more pronounced in the LI+MR group than in the LI group. Furthermore, LI+MR caused significantly greater improvements in all GV metrics including SDBG (P=0·005), CV (P=0·002), MAGE (P=0·016) and AUCpp (P<0·001) than did LI. LI+MR (v. LI) was independently associated with improvements in GV after adjustment of covariates (all P<0·05). Our study showed that LI+MR led to significantly greater improvements in GV compared with LI, suggesting that LI+MR could be an effective treatment to alleviate glucose excursions.

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