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Glycemic excursions are positively associated with changes in duration of asymptomatic hypoglycemia after treatment intensification in patients with type 2 diabetes

  • Jun-Sing Wang
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • I.-Te Lee
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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  • Wen-Jane Lee
    Affiliations
    Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
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  • Shi-Dou Lin
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang-Hua Christian Hospital, Chang-Hua, Taiwan
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  • Shih-Li Su
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang-Hua Christian Hospital, Chang-Hua, Taiwan
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  • Shih-Te Tu
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang-Hua Christian Hospital, Chang-Hua, Taiwan
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  • Yao-Hsien Tseng
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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  • Shih-Yi Lin
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Wayne Huey-Herng Sheu
    Correspondence
    Correspondence to: Taichung Veterans General Hospital, #1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan. Tel.: +886 4 2359 2525; fax: +886 4 2374 1318.
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan

    School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Published:January 13, 2016DOI:https://doi.org/10.1016/j.diabres.2015.12.010

      Highlights

      • Duration of asymptomatic hypoglycemia was monitored with CGM in type 2 diabetes.
      • Post treatment MAGE was associated with hypoglycemia duration change from baseline.
      • The association was independent of treatment allocation and post treatment HbA1c.

      Abstract

      Aim

      The aim of this study was to examine the association between glycemic excursions and duration of hypoglycemia after treatment intensification in patients with type 2 diabetes (T2D).

      Methods

      Patients with T2D on oral anti-diabetes drug (OAD) with glycated hemoglobin (HbA1c) of 7.0–11.0% were switched to metformin monotherapy (500 mg thrice daily) for 8 weeks, followed by randomization to either glibenclamide or acarbose as add-on treatment for 16 weeks. Glycemic excursions were assessed as mean amplitude of glycemic excursions (MAGE) with 72-h ambulatory continuous glucose monitoring (CGM) before randomization and at the end of study. Hypoglycemia was defined as sensor glucose level of less than 60 mg/dl in two or more consecutive readings from CGM.

      Results

      A total of 50 patients (mean age 53.5 ± 8.2 years, male 48%, mean baseline HbA1c 8.4 ± 1.2%) were analyzed. Duration of hypoglycemia significantly increased after treatment with glibenclamide (from 5.5 ± 13.8 to 18.8 ± 35.8 min/day, p = 0.041), but not with acarbose (from 2.9 ± 10.9 to 14.7 ± 41.9 min/day, p = 0.114). Post treatment MAGE was positively associated with change from baseline in duration of hypoglycemia after treatment with either glibenclamide (β coefficient 0.345, p = 0.036) or acarbose (β coefficient 0.674, p = 0.046). The association remained significant after multivariate adjustment (p < 0.05 for all models).

      Conclusions

      Post treatment glycemic excursions are associated with changes in duration of hypoglycemia after treatment intensification with OAD in patients with T2D. Glycemic excursions should be an important treatment target for T2D to reduce the risk of hypoglycemia.

      Keywords

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