Glycemic Variability Is Associated with Frequency of Blood Glucose Testing and Bolus: Post Hoc Analysis Results from the ProAct Study

Abstract

Introduction: The ProAct study has shown that a pump switch to the Accu-Chek Ò Combo system (Roche Diagnostics Deutschland GmbH, Mannheim, Germany) in type 1 diabetes patients results in stable glycemic control with significant improvements in glycated hemoglobin (HbA1c) in patients with unsatisfactory baseline HbA1c and shorter pump usage time. Patients and Methods: In this post hoc analysis of the ProAct database, we investigated the glycemic control and glycemic variability at baseline by determination of several established parameters and scores (HbA1c, hypoglycemia frequency, J-score, Hypoglycemia and Hyperglycemia Indexes, and Index of Glycemic Control) in participants with different daily bolus and blood glucose measurement frequencies (less than four day, four or five per day, and more than five per day, in both cases). The data were derived from up to 299 patients (172 females, 127 males; age [mean -SD], 39.4 -15.2 years; pump treatment duration, 7.0 -5.2 years). Results: Participants with frequent glucose readings had better glycemic control than those with few readings (more than five readings per day vs. less than four readings per day: HbA1c, 7.2 -1.1% vs. 8.0 -0.9%; mean daily blood glucose, 151 -22 mg/dL vs. 176 -30 mg/dL; percentage of readings per month >300 mg/dL, 10 -4% vs. 14 -5%; percentage of readings in target range [80-180 mg/dL], 59% vs. 48% [P < 0.05 in all cases]) and had a lower glycemic variability ( J-score, 49 -13 vs. 71 -25 [P < 0.05]; Hyperglycemia Index, 0.9 -0.5 vs. 1.9 -1.2 [P < 0.05]; Index of Glycemic Control, 1.9 -0.8 vs. 3.1 -1.6 [P < 0.05]; Hypoglycemia Index, 0.9 -0.8 vs. 1.2 -1.3 [not significant]). Frequent self-monitoring of blood glucose was associated with a higher number of bolus applications (6.1 -2.2 boluses/day vs. 4.5 -2.0 boluses/day [P < 0.05]). Therefore, a similar but less pronounced effect on glycemic variability in favor of more daily bolus applications was observed (more than five vs. less than four bolues per day: J-score, 57 -17 vs. 63 -25 [not significant]; Hypoglycemia Index, 1.0 -1.0 vs. 1.5 -1.4 [P < 0.05]; Hyperglycemia Index, 1.3 -0.6 vs. 1.6 -1.1 [not significant]; Index of Glycemic Control, 2.3 -1.1 vs. 3.1 -1.7 [P < 0.05]). Conclusions: Pump users who perform frequent daily glucose readings have a better glycemic control with lower glycemic variability.

Factors associated with high levels of glycated haemoglobin in patients with type 1 diabetes: a multicentre study in Brazil

“…Some studies suggest that patients with DM1 undergoing close monitoring of diabetes through regular HbA1c measurements, blood glucose self-monitoring and regular medical appointments had lower levels of HbA1c. 13 27 28 We found in bivariate analysis, but not in multiple variable analyses, that those self-monitoring blood glucose on a regular basis had lower HbA1c levels. The failure of our multiple variable analyses to show this association may derive from the method that we used to obtain data on blood glucose self-monitoring, which was self-reported, not relying on diaries or other more accurate sources to quantify the daily frequency of self-monitoring in a typical day.…”

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

“…A previous study has demonstrated that improvements in glycemic control and glycemic variability were associated with an increased frequency of blood glucose testing and administration of bolus insulin. 30 Other studies have demonstrated that fluctuations in blood glucose levels may contribute more to outcomes than constant high blood glucose concentrations. [31][32][33][34][35] As measurements of HbA 1c do not reflect glycemic variability and target HbA 1c values may be achieved while still experiencing marked daily glycemic fluctuations, people with T1D may regard reducing glucose variability and improving TIR to be as important as achieving their target HbA 1c value.…”

Behavioral Patterns and Associations with Glucose Control During 12-Week Randomized Free-Living Clinical Trial of Day and Night Hybrid Closed-Loop Insulin Delivery in Adults with Type 1 Diabetes

“…Other studies investigated associations between behavioral patterns and glycemic control. Pfützner et al 9 reported that pump users performing more frequent fingerstick glucose measurements have better glycemic control and lower glucose variability. This is consistent with our findings that during sensor-augmented pump therapy, the number of fingerstick measurements is associated with lower glucose variability, whereas displaying no such trend during closed-loop period.…”