Glycemic variability evaluated by continuous glucose monitoring system is associated with the 10-y cardiovascular risk of diabetic patients with well-controlled HbA1c

Tang, Xixiang; Li, Suhua; Wang, Yina; Wang, Manman; Yin, Qian; Mu, Panwei; Lin, Shuo; Qian, Xiaoxian; Ye, Xiaoming; Chen, Yanming

doi:10.1016/j.cca.2016.08.004

Cited by 70 publications

(44 citation statements)

References 23 publications

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“…In this study, the incidence of hypoglycemia was low and showed no difference between the two groups. This could be due to the short trial period and controlled titration, preventing Increased glucose fluctuation is known to be associated with elevated risks of mortality [31] and cardiovascular disorders [32]. Although several reports have compared daily glucose variability with the use of IDeg or IGla, almost all of them involved patients with type 1 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of insulin degludec U100 and insulin glargine U100 in combination with meal-time bolus insulin in hospitalized patients with type 2 diabetes: an open-label, randomized controlled study

et al. 2019

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The short-term efficacy and safety of insulin degludec U100 (IDeg) in patients with type 2 diabetes have not been reported widely. We compared insulin IDeg and insulin glargine U100 (IGla) for glycemic control and glucose variability in hospitalized patients with type 2 diabetes. In an open-label, multicenter, randomized controlled trial, 74 patients were randomly assigned to either the IDeg (36 patients) or IGla (38 patients) group and were administered with basal-bolus therapy during hospitalization. Following the start of the treatment, on day 11, glucose variability was assessed by continuous glucose monitoring. A fasting blood glucose level of 110 mg/dL and 2-hour postprandial blood glucose level of 180 mg/dL throughout at least one day during the observation period were achieved in 31.3% (10/32) and 30.6% (11/36) of the patients in the IDeg and IGla groups, respectively. The 6-point self-monitoring of blood glucose profiles showed a significant difference between the two groups. On day 7, the intra-day variation was larger in the IDeg group than in the IGla group. The incidence of hypoglycemia or glucose variability was comparable in the two groups. This study suggests that short-term efficacy and safety of IDeg and IGla in patients with type 2 diabetes during the initial phase of basal-bolus therapy were comparable, and these results can help in deciding which treatment to opt for.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of insulin degludec U100 and insulin glargine U100 in combination with meal-time bolus insulin in hospitalized patients with type 2 diabetes: an open-label, randomized controlled study

et al. 2019

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“…GV after acute stroke, according to four‐point glucose profiles, has been associated with increased CV events and mortality . GV measured using MAGE has been associated with a 10‐year CV risk, while GV according to seven‐point profiles, SD and CoV, has been associated with QTc prolongation in those with T2DM . Intervention studies would provide much needed insight into the relationship between GV and long‐term outcomes; we are not aware of any intervention studies to investigate the long‐term impact of CGM‐derived measures of GV in T1DM.…”

Section: Glycaemic Variability and Macrovascular Outcomesmentioning

confidence: 99%

“…39 GV measured using MAGE has been associated with a 10-year CV risk, while GV according to seven-point profiles, SD and CoV, has been associated with QTc prolongation in those with T2DM. 40,41 Intervention studies would provide much needed insight into the relationship between GV and long-term outcomes; we are not aware of any intervention studies to investigate the long-term impact of CGM-derived measures of GV in T1DM. In T2DM, investigators of the HEART2D study could not show any CV benefits as the result of tightly controlling variations in post-prandial glucose.…”

Section: Glycaemic Variability and Macrovascular Outcomesmentioning

confidence: 99%

Glycaemic variability: The under‐recognized therapeutic target in type 1 diabetes care

Wilmot

Choudhary

Leelarathna

et al. 2019

Diabetes Obesity Metabolism

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Type 1 diabetes mellitus (T1DM) remains one of the most challenging long‐term conditions to manage. Despite robust evidence to demonstrate that near normoglycaemia minimizes, but does not completely eliminate, the risk of complications, its achievement has proved almost impossible in a real‐world setting. HbA1c to date has been used as the gold standard marker of glucose control and has been shown to reflect directly the risk of diabetes complications. However, it has been recognized that HbA1c is a crude marker of glucose control. Continuous glucose monitoring (CGM) provides the ability to measure and observe inter‐ and intraday glycaemic variability (GV), a more meaningful measure of glycaemic control, more relevant to daily living for those with T1DM. This paper reviews the relationship between GV and hypoglycaemia, and micro‐ and macrovascular complications. It also explores the impact on GV of CGM, insulin pumps, closed‐loop technologies, and newer insulins and adjunctive therapies. Looking to the future, there is an argument that GV should become a key determinant of therapeutic success. Further studies are required to investigate the pathological and psychological benefits of reducing GV.

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“…A study has shown that glycemic variability is an independent risk factor for cardiovascular risk in T2DM patients with good glycemic control. Mean amplitudes of glycemic excursion (MAGE) was shown to be an independent factor for high 10-year cardiovascular risk [19]. In our study, MAGE was 77.24 (± 22.50) mg/ dL.…”

Section: Discussionmentioning

confidence: 52%

“…In our study, there were only 0.22 mean episodes of hypoglycemia. Glycemic variability is common concern in patients with T2DM due to its potential to cause adverse impact mainly on the cardiac health and other complications [18][19][20][21]. Several factors including diet, exercise, oxidative stress and psychological factors contribute to the variation in level of glucose [22][23].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2019

Int J Diabetes Clin Res

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Background: Many patients with type 2 diabetes mellitus (T2DM) are on insulin analogues which are costly as well as usage of higher units of insulin on a daily basis increases the cost of the monthly therapy. Concentrated insulin are a way forward for patients who needs higher units of insulin especially Human insulin which address the issues of higher cost and the need for higher concentration in the same or lesser volume of insulin. However, data on 24-hour glycemic control with concentrated insulin in Indian T2DM patients are limited. Hence, this study was conducted to study 24hour glycemic control in T2DM patients treated with U-200 by measuring the variability in 24-hr blood glucose profile measured using a continuous glucose monitoring (CGM) device over 6 days. Material and methods: In this prospective, open label single arm, two center study, adult T2DM patients on treatment with human insulin (regular/NPH/Premix) on stable insulin dose were treated with U-200 for 6 days. Variability in 24-hour blood glucose profile was measured by estimating mean amplitude of glucose excursions (MAGE). Duration and frequency of hypoglycemic (< 70 mg/dl) and hyperglycemic (> 150 mg/dl) episodes were recorded. Results: Sixty patients (mean age of 55.47 ± 9.68 years) were included. Mean number of hyperglycemic and hypoglycemic episodes were 2.64 and 0.22 with mean duration of 165.16 min and 27.35 min respectively. Blood glucose levels were within the normal limits (70-150 mg/dL) for 62.35% of time. MAGE was 77.24 ± 22.50 mg/dL. In this study, not a single patient experienced any adverse event. Conclusion: U200 insulin led to less glycemic variability, minimal hypoglycemia and efficient glucose control in Indian T2DM patients.

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Glycemic variability evaluated by continuous glucose monitoring system is associated with the 10-y cardiovascular risk of diabetic patients with well-controlled HbA1c

Cited by 70 publications

References 23 publications

Efficacy and safety of insulin degludec U100 and insulin glargine U100 in combination with meal-time bolus insulin in hospitalized patients with type 2 diabetes: an open-label, randomized controlled study

Efficacy and safety of insulin degludec U100 and insulin glargine U100 in combination with meal-time bolus insulin in hospitalized patients with type 2 diabetes: an open-label, randomized controlled study

Glycaemic variability: The under‐recognized therapeutic target in type 1 diabetes care

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