Relationship between glycated hemoglobin level and duration of hypoglycemia in type 2 diabetes patients treated with sulfonylureas: A multicenter cross‐sectional study

Abstract

Aims/Introduction Sulfonylurea‐related hypoglycemia increases the risk of cardiovascular sequela, such as cardiac arrhythmia. This study aimed to clarify the relationship between the level of glycated hemoglobin (HbA1c) and the duration of hypoglycemia in type 2 diabetes patients treated with sulfonylureas. Materials and Methods Glucose levels in the enrolled patients (n = 300) were investigated with a professional continuous glucose monitoring device in the outpatient setting at six diabetes centers in Japan. Results A total of 269 participants completed the study. The duration of hypoglycemia with glucose values of <54 mg/dL was significantly longer in patients with an HbA1c level of ≤6.4% than in those with an HbA1c level of ≥8.0%, and that of hypoglycemia with glucose values of <70 mg/dL was significantly longer in patients with an HbA1c level of ≤6.4%, 6.5–6.9% or 7.0–7.4% than in those with an HbA1c level of ≥8.0%. Patients with an HbA1c level of ≤6.4% were exposed to glucose values of <70 mg/dL for >10% of the time in daily life (6.8 ± 5.6 min/h). The duration of hypoglycemia with glucose values of <70 mg/dL was longer at night than during the daytime, and the nadir of glucose values occurred between 03.00 and 05.00 hours irrespective of HbA1c level. The duration of hypoglycemia was associated with the duration of diabetes and sulfonylurea dose. Conclusions The duration of hypoglycemia was inversely correlated with HbA1c level and was longer during the night‐time than daytime in type 2 diabetes patients treated with sulfonylureas.

Effect of the FreeStyle Libre™ flash glucose monitoring system on glycemic control in individuals with type 2 diabetes treated with basal–bolus insulin therapy: An open label, prospective, multicenter trial in Japan

“…In Japan, insulin dose titration for type 2 diabetes is generally physician‐led, and poor patient concordance with insulin regimens is acknowledged as an issue 20 . Most participants (92%) in the current study used fixed insulin doses; 17% dose‐adjusted for the current glucose level and 14% for their meals.…”

“…Information on the frequency of hypoglycemia during treatment of diabetes in non-Western countries is limited [18][19][20] , and hypoglycemia is a great concern for patients using insulin in Japan 21 . In the present study, a low level of hypoglycemia was observed at baseline, and 27% of participants did not experience glucose levels <70 mg/dL.…”

“…Mean total daily insulin doses of 70-90 units are reported in trials with CGM for white people with type 2 diabetes 6,7 , which is approximately threefold greater than those observed in the present study. Another explanation for the low baseline level of hypoglycemia might be the investigators' high awareness of hypoglycemia as an adverse effect of insulin 20 and its associated risks 21,23 , particularly in an aging population 24 . Furthermore, the concerns and fears of the patients for hypoglycemia are high in Japan 25 .…”

“…The current results, along with existing data, show the benefits of utilizing flash glucose monitoring technology 5,7,8,[31][32][33][34][35] or real-time CGM in type 2 diabetes patients treated with insulin 4,6 . In Japan, insulin dose titration for type 2 diabetes is generally physician-led, and poor patient concordance with insulin regimens is acknowledged as an issue 20 . Most participants (92%) in the current study used fixed insulin doses; 17% dose-adjusted for the current glucose level and 14% for their meals.…”

Potential Effects of COVID-19 on Cytochrome P450-Mediated Drug Metabolism and Disposition in Infected Patients

“…Similarly, for diabetes there are several options for patients. Sulfonylureas are a class of drugs that needs dose adjustment or discontinuation due to the inherent risk of hypoglycemia when given to non-COVID-19 patients [ 93 ]. Since CYP2C9 enzyme and CAR (receptor regulating the enzyme) are affected by COVID-19-related inflammation [ 84 ], it is likely that sulfonylureas will accumulate, leading to more severe hypoglycemia.…”