scholarly journals Hypoglycemia in type 2 diabetes patients treated with insulin: the advantages of continuous glucose monitoring

2014 ◽  
Vol 17 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Vadim Valer'evich Klimontov ◽  
Alexander Ivanovich Tsiberkin ◽  
Olga Nikolaevna Fazullina ◽  
Marina Alekseevna Prudnikova ◽  
Nadezhda Viktorovna Tyan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Insulin Regimen ◽  
Premixed Insulin ◽  
Dipeptidyl Peptidase 4 ◽  
Retrospective Data Analysis ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Bolus Insulin

Aims.  To determine the incidence and risk factors for hypoglycemia in elderly insulin-treated type 2 diabetes mellitus (T2DM) patients by means of continuous glucose monitoring (CGM). Materials and Methods.  We observed seventy-six hospitalized patients with T2DM, aged 65 to 79 years. Treatment with basal insulin (n=36), premixed insulin (n=12) or basal-bolus insulin regimen (n=28) was followed by metformin (n=44), glimepiride (n=14) and dipeptidyl peptidase-4 inhibitors (n=14). 2-days CGM with retrospective data analysis was performed in all patients. During CGM, three fasting and three 2-h postprandial finger-prick glucose values were obtained daily with portable glucose meter. Results.  Hypoglycemia (identified as blood glucose

scholarly journals Acute effect of add-on therapy with tofogliflozin, a sodium glucose co‐transporter 2 inhibitor, on 24-hour glucose profile and glycemic variability evaluated by continuous glucose monitoring in patients with type 2 diabetes receiving dipeptidyl peptidase-4 inhibitors.

2021 ◽  
Author(s):  
Yoshimasa Aso ◽  
Toshie Iijima ◽  
Soichiro Hosonuma ◽  
Hidetaka Kurai ◽  
Hayato Kanitani ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Mean Amplitude ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase 4 ◽  
Glucose Profile ◽  
Dipeptidyl Peptidase 4 Inhibitors

Aim: To investigate acute effects of add-on therapy with the sodium glucose co‐transporter 2 inhibitor tofogliflozin to dipeptidyl peptidase (DPP)-4 inhibitors on 24-hour glucose profile and glycemic variability evaluated by continuous glucose monitoring (CGM) in patients with type 2 diabetes. Patients and methods: We studied 17 patients with type 2 diabetes who were hospitalized for glycemic control. CGM was performed for 7 consecutive days in the last week of hospitalization. Tofogliflozin 20 mg/day was started on day 4 after initiating CGM and was administered to 10 patients receiving DPP-4 inhibitors and 7 patients not receiving DPP-4 inhibitors. We compared several CGM parameters between day 2 to 3 (ie, before treatment with tofogliflozin) and day 5 to 6 (ie, after starting treatment with tofogliflozin). Results: After starting treatment with tofogliflozin, mean 24-hour glucose and postprandial glucose after each meal were significantly decreased in both groups of patients. Time in range (ie, at a glucose level of 70-180 mg/dL) was significantly increased in both groups. The standard deviation of 24-hour glucose and mean amplitude of glycemic excursions, 2 indexes of glycemic variability, were significantly decreased in patients receiving DPP-4 inhibitors but were unchanged in those not receiving these drugs. Conclusions: Add-on therapy with tofogliflozin to DPP-4 inhibitors acutely reduces 24-hour glucose levels and improves glycemic variability in patients with type 2 diabetes.

Comparing Patch vs. Pen Bolus Insulin Delivery in Type 2 Diabetes Using Continuous Glucose Monitoring Metrics and Profiles

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 73-LB
Author(s):  
MARY L. JOHNSON ◽  
DARLENE M. DREON ◽  
BRIAN L. LEVY ◽  
SARA RICHTER ◽  
DEBORAH MULLEN ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Insulin Delivery ◽  
Bolus Insulin

scholarly journals Hypoglycemia Incidence and Factors Associated in a Cohort of Patients With Type 2 Diabetes Hospitalized in General Ward Treated With Basal Bolus Insulin Regimen Assessed by Continuous Glucose Monitoring

2019 ◽  
Vol 14 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Ana María Gómez ◽  
Angélica Imitola Madero ◽  
Diana Cristina Henao Carrillo ◽  
Martín Rondón ◽  
Oscar Mauricio Muñoz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
General Ward ◽  
Insulin Regimen ◽  
Factors Associated ◽  
Bolus Insulin ◽  
Mean Glucose ◽  
Basal Bolus

Introduction: Continuous glucose monitoring (CGM) is a better tool to detect hyper and hypoglycemia than capillary point of care in insulin-treated patients during hospitalization. We evaluated the incidence of hypoglycemia in patients with type 2 diabetes (T2D) treated with basal bolus insulin regimen using CGM and factors associated with hypoglycemia. Methods: Post hoc analysis of a prospective cohort study. Hypoglycemia was documented in terms of incidence rate and percentage of time <54 mg/dL (3.0 mmol/L) and <70 mg/dL (3.9 mmol/L). Factors evaluated included glycemic variability analyzed during the first 6 days of basal bolus therapy. Results: A total of 34 hospitalized patients with T2D in general ward were included, with admission A1c of 9.26 ± 2.62% (76.8 ± 13 mmol/mol) and mean blood glucose of 254 ± 153 mg/dL. There were two events of hypoglycemia below 54 mg/dL (3.0 mmol/L) and 11 events below 70 mg/dL (3.9 mmol/L) with an incidence of hypoglycemic events of 0.059 and 0.323 per patient, respectively. From second to fifth day of treatment the percentage of time in range (140-180 mg/dL, 7.8-10.0 mmol/L) increased from 72.1% to 89.4%. Factors related to hypoglycemic events <70 mg/dL (3.9 mmol/L) were admission mean glucose (IRR 0.86, 95% CI 0.79, 0.95, P < .01), glycemic variability measured as CV (IRR 3.12, 95% CI 1.33, 7.61, P < .01) and SD, and duration of stay. Conclusions: Basal bolus insulin regimen is effective and the overall incidence of hypoglycemia detected by CGM is low in hospitalized patients with T2D. Increased glycemic variability as well as the decrease in mean glucose were associated with events <70 mg/dL (3.9 mmol/L).

Switching from Premixed Insulin To Basal Insulin Analogue For Type 2 Diabetes and Role of Dipeptidyl Peptidase-4 Inhibitors

2017 ◽  
Vol 126 (05) ◽  
pp. 268-276 ◽  
Author(s):  
Fernando Gómez-Peralta ◽  
Cristina Abreu ◽  
Gustavo Mora-Navarro ◽  
Pilar López-Morandeira ◽  
Esteban Pérez-Gutierrez ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Basal Insulin ◽  
Insulin Analogue ◽  
Dipeptidyl Peptidase ◽  
Premixed Insulin ◽  
Dipeptidyl Peptidase 4 ◽  
Metformin Group ◽  
Dipeptidyl Peptidase 4 Inhibitors

Abstract Introduction This study aimed to confirm the usefulness of basal insulin analogue plus oral antidiabetic drugs (OADs) for type 2 diabetes (T2D) patients inadequately controlled with premixed insulin with/without OADs and assess the role of dipeptidyl peptidase-4 (DPP-4) inhibitors within this regimen in clinical practice. Methods Spanish retrospective observational study that included 186 T2D patients with glycosylated hemoglobin (HbA1c) >7% (53 mmol/mol) despite premixed insulin with/without OADs who had been switched to basal insulin analogue plus OADs. Study data describing the situation before the treatment switch and 6 months later was retrospectively retrieved from patients’ medical charts. Results Switching to a basal insulin plus OADs decreased HbA1c (−1.0%, p<0.001), fasting (−38.1 mg/dl, p<0.001) and postprandial glycemia (−36.1 mg/dl, p<0.001), with reduced body weight (−1.1 kg, p<0.001) and hypoglycemic episodes (−17.5%, p<0.001). 68 (36.6%) patients received a basal insulin plus DPP-4 inhibitor±metformin and 74 (39.8%) plus metformin only. The DPP-4 inhibitor±metformin group showed a greater HbA1c reduction than the metformin group (1.3±1.4% vs. 0.9±1.0%, p=0.022), with no significant differences between groups in hypoglycemic episodes. Conclusions Basal insulin analogue plus OADs may be a useful treatment for type 2 diabetes patients inadequately controlled with premixed insulin. Administering DPP-4 inhibitors within this regimen may contribute to improve patients’ glycemia, with a favorable weight-change profile and without increasing hypoglycemia risk.

scholarly journals The Effect of Discontinuing Continuous Glucose Monitoring in Adults with Type 2 Diabetes Treated with Basal Insulin

2021 ◽  
Author(s):  
Grazia Aleppo ◽  
Roy W. Beck ◽  
Ryan Bailey ◽  
Katrina J. Ruedy ◽  
Peter Calhoun ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Basal Insulin ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Time In Range ◽  
Bolus Insulin ◽  
Design And Methods

<b>Objective: </b>To explore the effect of discontinuing continuous glucose monitoring (CGM) after 8 months of CGM use in adults with type 2 diabetes treated with basal without bolus insulin. <p><b>Research Design and Methods:</b> Multi-center trial with an initial randomization to either real-time CGM or blood glucose monitoring (BGM) for 8 months, followed by 6 months in which the BGM Group continued to use BGM (N=57) and the CGM Group was re-randomized either to continue CGM (N=53) or discontinue CGM with resumption of BGM for glucose monitoring (N=53). </p> <p><b>Results: </b>In the group that discontinued CGM, mean time in range 70-180 mg/dL (TIR), which improved from 38% prior to initiating CGM to 62% after 8 months of CGM, decreased after discontinuing CGM to 50% at 14 months (mean change from 8 to 14 months = -12%, 95% CI -21% to -3%, P=0.01). In the group continuing CGM, there was little change in TIR from 8 to 14 months (baseline 44%, 8 months 56%, 14 months 57%; mean change 8 to 14 months = 1%, 95% CI -11% to 12%, P=0.89). Comparing the two groups at 14 months, the adjusted treatment group difference in mean TIR was -6% (95% CI -16% to 4%, P=0.20).</p> <p><b>Conclusions: </b>In adults with type 2 diabetes treated with basal insulin who had been using real-time CGM for 8 months, discontinuing CGM resulted in a loss of about half of the initial gain in TIR that had been achieved during CGM use.</p>

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