Association of glycemic variability and hypoglycemia with distal symmetrical polyneuropathy in adults with type 1 diabetes

Previous studies exploring the influence of glycemic variability (GV) on the pathogenesis of distal symmetrical polyneuropathy (DSPN) in type 1 diabetes (T1DM) produced conflicting results. The aim of this study was to assess the relationship between GV and DSPN in T1DM. Adults with T1DM were included in this cross-sectional study and asked to undergo 3-day CGM. GV quantified by coefficient of variation (CV) and mean amplitude of glucose excursions (MAGE) were obtained from CGM. Clinical characteristics and biochemical assessments were collected for analysis. The study comprised 152 T1DM patients (53.9% males) with mean age of 44.2 year. Higher levels of age and duration of diabetes and lower levels of total cholesterol, LDL, fasting C-peptide and postprandial C-peptide were observed in DSPN subjects. DSPN groups displayed a higher blood glucose between 00:00 and 12:59 according to the CGM profile. Higher MAGE and CV were associated with increased risk of DSPN in the fully adjusted model. Meanwhile, a significant association between measurements of hypoglycemia, especially nocturnal hypoglycemia, and DSPN was found after multiple tests. CGM parameters describing the glycemic variability and hypoglycemia were potential risk factors for DSPN in adults with T1DM.

Efficacy and Safety of Insulin Degludec/Insulin Aspart Compared with a Conventional Premixed Insulin or Basal Insulin: A Meta-Analysis

Insulin degludec/insulin aspart (IDegAsp) is a novel co-formulation of 70% insulin degludec and 30% insulin aspart. The present meta-analysis was conducted to assess the efficacy and safety of IDegAsp compared with a conventional premixed insulin or basal insulin. We extracted data from citation databases, including PubMed, EMBASE, and the Cochrane Library, since inception to 2021. We calculated the mean differences for hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), self-measured mean glucose, and postprandial glucose (PPG) and odds ratios for confirmed hypoglycemia events. Compared with twice-daily conventional premixed insulin, twice-daily IDegAsp showed a similar effect on changes in HbA1c, but it significantly reduced FPG and self-measured mean glucose levels. Furthermore, compared to once-daily basal insulin, once-daily IDegAsp had a similar effect on changes in HbA1c, but it significantly reduced self-measured mean glucose and PPG levels. The risk of overall confirmed hypoglycemia was similar between treatments; however, the risk of nocturnal hypoglycemia events was significantly lower with IDegAsp than with conventional premixed insulin and basal insulin. Thus, IDegAsp was more effective than conventional premixed insulin and basal insulin at reducing blood glucose with fewer nocturnal hypoglycemia events.

Effects of Switching from Degludec to Glargine U300 in Patients with Type 1 Diabetes Having Large Day-to-Day Glycemic Variability: A Retrospective Study

Background: Degludec (Deg) and Glargine U300 (Gla-300) are new insulin analogues with longer and smoother pharmacodynamic action than Glargine U100. Both improve glycemic variability (GV) unlike Glargine U100. However, it is not clear which insulin analogue has a better effect on GV in insulin-dependent type 1 diabetes. We evaluated the effects of switching from Deg to Gla-300 on day-to-day GV in patients with insulin-dependent type 1 diabetes treated with Deg.Methods: We conducted a retrospective study on 22 insulin-dependent type 1 diabetes patients having large day-to-day GV or frequent hypoglycemia who were treated with multiple insulin injection therapy including Deg and were advised to switch from Deg to Gla-300. We evaluated day-to-day GV and frequency of hypoglycemia in two groups. The first group included patients whose treatment was changed to Gla-300, and the second group included patients who opted to continue receiving Deg. We evaluated the change in standard deviation (SD) of fasting blood glucose (SD-FBG) calculated from self-monitoring of blood glucose (SMBG) and frequency of hypoglycemia (total, severe, and nocturnal).Results: SD-FBG and frequency of nocturnal hypoglycemia decreased in Gla-300 group compared to those in Deg group. The change in SD-FBG had a negative correlation with SD-FBG and hemoglobin A1c (HbA1c) at baseline and positive correlation with serum albumin levels at baseline in Gla-300 group. On the other hands, the change in SD-FBG had no correlation with these markers in Deg group.Conclusions: Switching from Deg to Gla-300 effectively stabilized blood glucose levels and decreased nocturnal hypoglycemia in insulin-dependent type 1 diabetes treated with Deg, especially in cases with low serum albumin, large GV, and high HbA1c.

Glucose Regulation Beyond HbA1c in Type 2 Diabetes Treated With Insulin: Real-World Evidence From the DIALECT-2 Cohort

OBJECTIVE To investigate glucose variations associated with HbA_1c in insulin treated patients with type 2 diabetes. <p>RESEARCH DESIGN AND METHODS Patients included in the Diabetes and Lifestyle Cohort Twente (DIALECT)-2 (n=79) were categorized in three HbA_1c categories: low, intermediate and high (≤ 53; 54–62 and ≥ 63 mmol/mol or ≤ 7, 7.1–7.8, ≥ 7.9%). Blood glucose time in range (TIR), time below range (TBR), time above range (TAR), glucose variability parameters, day and night duration and frequency of TBR and TAR episodes were determined by continuous glucose monitoring (CGM), using the FreeStyle Libre sensor and compared between HbA_1c categories.</p> <p>RESULTS <a>CGM was performed for a median [interquartile range] of 10 [7-12] days/ patient. </a>TIR was not different for low and intermediate HbA_1c categories:(76.8% [68.3–88.2] vs 76.0% [72.5.0–80.1]), whereas in the low categoryTBR was higher and TAR lower (7.7% [2.4–19.1] vs 0.7% [0.3–6.1], and 8.2% [5.7–17.6] vs 20.4% [11.6–27.0], respectively, <i>p </i>< 0.05). Patients in the highest HbA_1ccategory had lower TIR (52.7% [40.9–67.3]) and higher TAR (44.1% [27.8–57.0]) than the other HbA_1ccategories (<i>p</i> < 0.05), but did not have less TBR during the night. All patients had more (0.06 ± 0.06/h vs 0.03 ± 0.03/h, <i>p </i>= 0.002) and longer (88.0 [45.0–195.5] vs 53.4 [34.4–82.8] minutes, <i>p </i>< 0.001) TBR episodes during the night than during the day. </p> <p>CONCLUSIONS In this study, a high HbA_1c did not reduce the occurrence of nocturnal hypoglycemia and low HbA_1c was not associated with the highest TIR. Optimal personalization of glycemic control requires the use of newer tools, including CGM-derived parameters. <br> </p>

Glucose Regulation Beyond HbA1c in Type 2 Diabetes Treated With Insulin: Real-World Evidence From the DIALECT-2 Cohort

OBJECTIVE To investigate glucose variations associated with HbA_1c in insulin treated patients with type 2 diabetes. <p>RESEARCH DESIGN AND METHODS Patients included in the Diabetes and Lifestyle Cohort Twente (DIALECT)-2 (n=79) were categorized in three HbA_1c categories: low, intermediate and high (≤ 53; 54–62 and ≥ 63 mmol/mol or ≤ 7, 7.1–7.8, ≥ 7.9%). Blood glucose time in range (TIR), time below range (TBR), time above range (TAR), glucose variability parameters, day and night duration and frequency of TBR and TAR episodes were determined by continuous glucose monitoring (CGM), using the FreeStyle Libre sensor and compared between HbA_1c categories.</p> <p>RESULTS <a>CGM was performed for a median [interquartile range] of 10 [7-12] days/ patient. </a>TIR was not different for low and intermediate HbA_1c categories:(76.8% [68.3–88.2] vs 76.0% [72.5.0–80.1]), whereas in the low categoryTBR was higher and TAR lower (7.7% [2.4–19.1] vs 0.7% [0.3–6.1], and 8.2% [5.7–17.6] vs 20.4% [11.6–27.0], respectively, <i>p </i>< 0.05). Patients in the highest HbA_1ccategory had lower TIR (52.7% [40.9–67.3]) and higher TAR (44.1% [27.8–57.0]) than the other HbA_1ccategories (<i>p</i> < 0.05), but did not have less TBR during the night. All patients had more (0.06 ± 0.06/h vs 0.03 ± 0.03/h, <i>p </i>= 0.002) and longer (88.0 [45.0–195.5] vs 53.4 [34.4–82.8] minutes, <i>p </i>< 0.001) TBR episodes during the night than during the day. </p> <p>CONCLUSIONS In this study, a high HbA_1c did not reduce the occurrence of nocturnal hypoglycemia and low HbA_1c was not associated with the highest TIR. Optimal personalization of glycemic control requires the use of newer tools, including CGM-derived parameters. <br> </p>

Simultaneous Reduction of Bilateral Anterior Shoulder Dislocation Following Nocturnal Hypoglycemia-Induced Convulsion Using the Boss-Holzach-Matter Technique

Bilateral anterior shoulder dislocation is rare. We describe the case of a 21-year-old male with bilateral anterior shoulder dislocation following a nocturnal, hypoglycemia-induced convulsion. The relatively uncommon Boss-Holzach-Matter technique provides an easy, atraumatic, and time-efficient self-reduction method to achieve simultaneous reduction of bilateral anterior shoulder dislocation, without the need for anesthesia or analgesia.