Twenty‐four‐hour variations in blood glucose level in Japanese type 2 diabetes patients based on continuous glucose monitoring

Abstract

Aims/IntroductionHigh fluctuations in blood glucose are associated with various complications. The correlation between glycated hemoglobin (HbA1c) level and fluctuations in blood glucose level has not been studied in Japanese patients with type 2 diabetes. In the present study, blood glucose profile stratified by HbA1c level was evaluated by continuous glucose monitoring (CGM) in Japanese type 2 diabetes patients.Materials and MethodsOur retrospective study included 294 patients with type 2 diabetes who were divided by HbA1c level into five groups (≥6.0 to <7.0%, ≥7.0 to <8.0%, ≥8.0 to <9.0%, ≥9.0 to <10.0% and ≥10%). The correlation between HbA1c level and CGM data was analyzed. The primary end‐point was the difference in blood glucose fluctuations among the HbA1c groups.ResultsThe mean blood glucose level increased significantly with increasing HbA1c (P trend < 0.01). The standard deviation increased with increases in HbA1c (P trend < 0.01). The mean amplitude of glycemic excursions did not vary significantly with HbA1c. The levels of maximum blood glucose, minimum blood glucose, each preprandial blood glucose, each postprandial maximum blood glucose, range of increase in postprandial glucose from pre‐meal to after breakfast, the area under the blood concentration–time curve >180 mg/dL and percentage of the area under the blood concentration–time curve >180 mg/dL were higher with higher HbA1c. Mean glucose level and pre‐breakfast blood glucose level were significant and independent determinants of HbA1c.ConclusionsIn Japanese patients treated for type 2 diabetes, the mean amplitude of glycemic excursions did not correlate with HbA1c, making it difficult to assess blood glucose fluctuations using HbA1c. Parameters other than HbA1c are required to evaluate fluctuations in blood glucose level in patients receiving treatment for type 2 diabetes.

Dipeptidyl peptidase‐4 inhibitor‐related bullous pemphigoid: A comparative study of 100 patients with bullous pemphigoid and diabetes mellitus

“…These specific features can be referred to as non‐inflammatory BP. Several Japanese studies have also suggested similar clinical findings showing less erythema and fewer urticarial lesions associated with DPP4i intake 10,20,21 . However, European studies have shown contradictory results and failed to reveal unique clinical and immunological characteristics for patients with DBP from their non‐DPP4i‐associated counterparts 15,23,24,29 .…”

“…20 In addition, previous reports have suggested that patients with DBP may present with a unique phenotype with fewer inflammatory lesions and less eosinophilic infiltration. 10,20,21 A strong association between the HLA-DQ*03:01 allele and DBP has also been noted in a Japanese cohort. 22 However, other contradictory reports showed the lack of any of the aforementioned features.…”

“…Several Japanese studies have also suggested similar clinical findings showing less erythema and fewer urticarial lesions associated with DPP4i intake. 10,20,21 However, European studies have shown contradictory results and failed to reveal unique clinical and immunological characteristics for patients with DBP from their non-DPP4i-associated counterparts. 15,23,24,29 In terms of disease severity, some Japanese studies have proposed that non-inflammatory DBP may present with lower disease activity and could be a mild form of BP.…”

“…However, it has been shown that DPP4i‐associated BP (DBP) may have a different pathomechanism from IBP targeting components of BP180 other than the NC16A 20 . In addition, previous reports have suggested that patients with DBP may present with a unique phenotype with fewer inflammatory lesions and less eosinophilic infiltration 10,20,21 . A strong association between the HLA‐DQ*03:01 allele and DBP has also been noted in a Japanese cohort 22 .…”

Changes in endothelial function during educational hospitalization and the contributor to improvement of endothelial function in type 2 diabetes mellitus

“…Hypoglycemia is considered to cause vascular endothelial dysfunction due to the associated increases in reactive oxygen species, catecholamines 29 , and proinflammatory cytokines 30 . We have assessed the relevance of hypoglycemia and glycemic variability in T2DM 4 , 31 – 34 . In particular, we reported the association between hypoglycemia and vascular endothelial function in a cross-sectional study of actual clinical cases 4 , the present study on changes before and after hospitalization therapy showed that the prevention of hypoglycemia is important for treatment that aims to achieve favorable vascular endothelial function.…”