Reduced Glucose Variability With Glucose-Dependent Versus Glucose-Independent Therapies Despite Similar Glucose Control and Hypoglycemia Rates in a Randomized, Controlled Study of Older Patients With Type 2 Diabetes Mellitus

Pratley, Richard E.; Rosenstock, Julio; Heller, Simon; Sinclair, Alan J.; Heine, Robert J.; Kiljański, Jacek; Brusko, Cynthia; Duan, Ran; Festa, Andreas

doi:10.1177/1932296818776993

Cited by 9 publications

(6 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…53 Similarly, CGM proved to be useful for investigating hypoglycemia and glycemic variability in the IMPERIUM study performed in moderately ill and/or frail older (≥65 years) individuals with inadequately controlled T2DM. 54 In the MOBILE RCT comparing CGM to SMBG in adults with T2DM treated with basal insulin without prandial or bolus insulin, improvement in key glycemic outcomes, including time-in-range and less time in hyperglycemia, was observed with CGM compared with SMBG in participants ≥65 years old (mean ± standard deviation age of 69±4 years), and was comparable with the treatment outcomes observed in younger participants. 55 A recent analysis of a heterogeneous non-critically ill inpatient population with diabetes on insulin therapy demonstrated good overall accuracy of CGM, even in the presence of comorbidities such as impaired renal function, cardiovascular and respiratory illnesses, and mild-to-moderate anemia.…”

Section: Dovepress 1697mentioning

confidence: 71%

Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities

Doucet,

Gourdy,

Meyer

et al. 2023

CIA

View full text Add to dashboard Cite

The population of older adults (≥65 years) with type 2 diabetes mellitus (T2DM) is diverse, encompassing individuals with varying functional capabilities, living arrangements, concomitant medical conditions, and life expectancies. Hence, their categorization into different patient profiles (ie, good health, intermediate health, poor health) may aid in clinical decision-making when establishing glycemic goals and pharmacological treatment strategies. Further granularity in assessing each patient profile through interdisciplinary collaboration may also add precision to therapeutic and monitoring decisions. In this review, we discuss with a multidisciplinary approach how to deliver the best benefit from advanced diabetes therapies and technologies to older adults with T2DM according to each patient profile. There remain however several areas that deserve further research in older adults with T2DM, including the efficacy and safety of continuous glucose monitoring and automated insulin delivery systems, the switch to once-weekly insulin, the effectiveness of multidisciplinary care models, and the use of supported telemedicine and remote blood glucose monitoring in the oldest-old (≥85 years) who particularly require the assistance of others.

show abstract

Section: Dovepress 1697mentioning

confidence: 71%

Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities

Doucet,

Gourdy,

Meyer

et al. 2023

CIA

View full text Add to dashboard Cite

show abstract

“…Moreover, the potential influences of antidiabetic treatments and concurrent medications on the association between HbA1c variability and DR in T2DM patients are unknown, which should be evaluated in future studies. For example, a previous study suggested that glucose-dependent therapies may be associated with lower within- and between-day glucose variability but similar HbA1c reductions and hypoglycemia duration as compared to glucose-independent strategies in old patients with T2DM 46 . In addition, several clinical studies have also suggested that sitagliptin 47 48 or dulaglutide 49 may be more effective than sulfonylureas in improving the glucose fluctuation.…”

Section: Discussionmentioning

confidence: 99%

“…therapies may be associated with lower within-and between-day glucose variability but similar HbA1c reductions and hypoglycemia duration as compared to glucose-independent strategies in old patients with T2DM [46]. In addition, several clinical studies have also suggested that sitagliptin [47,48] or dulaglutide [49] may be more effective than sulfonylureas in improving the glucose fluctuation.…”

Section: Continuedmentioning

confidence: 99%

Association Between the Variability of Glycated Hemoglobin and Retinopathy in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

Visit-to-visit variability of glycated hemoglobin (HbA1c) is a marker of long-term glycemic fluctuation, which has been related to increased risk of macrovascular complications in patients with type 2 diabetes mellitus (T2DM). The association between HbA1c variability and retinopathy in patients with T2DM, however, has been inconsistent in previous studies. In order to fully evaluate the above association, we conducted a meta-analysis. Observational studies related to the aim of the meta-analysis were identified by search of PubMed, Web of Science, and Embase databases. Studies with HbA1c variability evaluated as the standard deviation (SD) and/or the coefficients of variation (CV) of HbA1c were included. The results were analyzed using a random-effects model that incorporated potential heterogeneity between studies. Twelve observational studies involving 44 662 T2DM patients contributed to the meta-analysis. Overall, 5150 (11.5%) patients developed retinopathy. Pooled results showed that compared to patients with lower HbA1c variability, T2DM patients with higher HbA1c-SD (relative risk [RR]: 1.48, 95% confidence interval [CI]: 1.24 to 1.78, p<0.001, I2=34%) and higher HbA1c-CV (RR: 1.29, 95% CI: 1.05 to 1.59, p=0.02, I2=0%) were both associated with higher risk of DR. For studies with HbA1c-SD, the association was not significantly affected by study characteristics such as country, study design, mean age, disease duration, adjustment of mean HbA1c, or quality scores (p for subgroup difference all>0.05). In conclusion, higher HbA1c variability may be associated with an increased risk of retinopathy in patients with T2DM.

show abstract

“…10 Studies have reported that patients with T2DM should not only reduce HbA1c to target levels, but also need to control GV to avoid hypoglycaemia and extensive postprandial glycaemic excursions. 11,12 A prospective cohort study showed that an increased CV was associated with the risk of all-cause mortality in patients with T2DM who had a well-controlled glucose status at long-term follow-up. 13 Therefore, CV serves as an important outcome indicator in clinical trials of CGM, and clarifying the factors that determine CV is essential for the management of T2DM and its complications.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have reported that patients with T2DM should not only reduce HbA1c to target levels, but also need to control GV to avoid hypoglycaemia and extensive postprandial glycaemic excursions 11,12 . A prospective cohort study showed that an increased CV was associated with the risk of all‐cause mortality in patients with T2DM who had a well‐controlled glucose status at long‐term follow‐up 13 .…”

Section: Introductionmentioning

confidence: 99%

Factors that determine glucose variability, defined by the coefficient of variation in continuous glucose monitoring values, in a Chinese population with type 2 diabetes

Wen,

Yang,

Yang

et al. 2023

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

AimsTo elucidate the clinical determinants of the coefficient of variation (CV) of glucose by analysing the pancreatic β‐cell function of subjects with type 2 diabetes mellitus (T2DM).MethodsA total of 716 Chinese subjects with T2DM were included. Continuous glucose monitoring (CGM) was used to assess blood glucose, and the CV was calculated. C‐peptide concentration at 0, 0.5, 1, 2 and 3 hours (Cp0h, Cp0.5h, Cp1h, Cp2h and Cp3h, respectively) was measured after a standard 100‐g steamed bun meal test to assess pancreatic β‐cell function. The determinants of glucose variability defined by the CV of CGM values were explored from two perspectives: the CV of qualitative variables and the CV of quantitative variables.ResultsOur data revealed that C‐peptide concentration (Cp0h, Cp0.5h, Cp1h, Cp2h, Cp3h), area under the curve for C‐peptide concentration at 0.5 and 3 hours (AUC‐Cp0.5h and AUC‐Cp3h) decreased with increasing CV quartile (P < 0.05). The CV was negatively correlated with homeostatic model assessment of β‐cell function index, C‐peptide concentration at all timepoints, and AUC‐Cp0.5h and AUC‐Cp3h (P < 0.001). Quantile regression analysis showed that AUC‐Cp0.5h had an overall negative effect on the CV in the 0.05 to 0.95 quartiles, and AUC‐Cp3h tended to have a negative effect on the CV in the 0.2 to 0.65 quartiles. After adjusting for confounders, multinomial logistic regression showed that each 1‐unit increase in AUC‐Cp0.5h was associated with a 31.7% reduction in the risk of unstable glucose homeostasis (CV > 36%; P = 0.036; odds ratio 0.683; 95% confidence interval 0.478‐0.976). We also identified the AUC‐Cp0.5h (0.735 ng/mL) and AUC‐Cp3h (13.355 ng/mL) cut‐off values for predicting unstable glucose homeostasis (CV >36%) in T2DM subjects.ConclusionOur study suggests that impaired pancreatic β‐cell function may be a clinical determining factor of CV of glucose in people with T2DM.

show abstract

Reduced Glucose Variability With Glucose-Dependent Versus Glucose-Independent Therapies Despite Similar Glucose Control and Hypoglycemia Rates in a Randomized, Controlled Study of Older Patients With Type 2 Diabetes Mellitus

Abstract: This CGM substudy in older patients with T2DM showed lower within- and between-day BG variability with glucose-dependent therapies but similar HbA1c reductions and hypoglycemia duration with glucose-independent strategies.

Cited by 9 publications

References 33 publications

Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities

Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities

Association Between the Variability of Glycated Hemoglobin and Retinopathy in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis

Factors that determine glucose variability, defined by the coefficient of variation in continuous glucose monitoring values, in a Chinese population with type 2 diabetes

Contact Info

Product

Resources

About