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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Article info
Publication history
Published online: January 13, 2016
Accepted:
December 27,
2015
Received in revised form:
November 27,
2015
Received:
September 28,
2015
Identification
Copyright
© 2016 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
