Hypoglycemia in type 2 diabetes patients treated with insulin: the advantages of continuous glucose monitoring
https://doi.org/10.14341/DM2014175-80
Abstract
Aims.
To determine the incidence and risk factors for hypoglycemia in elderly insulin-treated type 2 diabetes mellitus (T2DM) patients by means of continuous glucose monitoring (CGM).
Materials and Methods.
We observed seventy-six hospitalized patients with T2DM, aged 65 to 79 years. Treatment with basal insulin (n=36), premixed insulin (n=12) or basal-bolus insulin regimen (n=28) was followed by metformin (n=44), glimepiride (n=14) and dipeptidyl peptidase-4 inhibitors (n=14). 2-days CGM with retrospective data analysis was performed in all patients. During CGM, three fasting and three 2-h postprandial finger-prick glucose values were obtained daily with portable glucose meter.
Results.
Hypoglycemia (identified as blood glucose <3.9 mmol/l) was registered in 17 (22%) patients by glucose meter and in 55 (72%) patients by CGM. Most of the CGM-registered hypoglycemic events (72%) were not recognized by patients. Nocturnal hypoglycemic events were revealed in 48 subjects (63%). Patients with hypoglycemia had lower interstitial glucose (median, 25?75 percentile: 7.0, 6.4?8.3 vs. 8.3, 7.4?8.5 mmol/l, p=0.01) and higher glucose variability (2.5, 1.9?3.1 vs. 1.8, 1.4?2.2 mmol/l, respectively; p=0.0008). There was no significant difference between the groups regarding daily insulin dose, HbA1c or T2DM duration. In a model of stepwise discriminant analysis, age, duration of insulin therapy, mean interstitial glucose levels and glycemic variability showed associations with hypoglycemia (accuracy rate 97.5%, p=0.005).
Conclusion.
The unrecognized hypoglycemia is a common complication in elderly T2DM patients on insulin therapy. Compared to conventional blood glucose monitoring, two-day CGM is superior in detection of asymptomatic hypoglycemia in this patient group. Age, duration of insulin therapy, mean glucose levels and glucose variability were associated with hypoglycemic events in elderly patients with T2DM.
To determine the incidence and risk factors for hypoglycemia in elderly insulin-treated type 2 diabetes mellitus (T2DM) patients by means of continuous glucose monitoring (CGM).
Materials and Methods.
We observed seventy-six hospitalized patients with T2DM, aged 65 to 79 years. Treatment with basal insulin (n=36), premixed insulin (n=12) or basal-bolus insulin regimen (n=28) was followed by metformin (n=44), glimepiride (n=14) and dipeptidyl peptidase-4 inhibitors (n=14). 2-days CGM with retrospective data analysis was performed in all patients. During CGM, three fasting and three 2-h postprandial finger-prick glucose values were obtained daily with portable glucose meter.
Results.
Hypoglycemia (identified as blood glucose <3.9 mmol/l) was registered in 17 (22%) patients by glucose meter and in 55 (72%) patients by CGM. Most of the CGM-registered hypoglycemic events (72%) were not recognized by patients. Nocturnal hypoglycemic events were revealed in 48 subjects (63%). Patients with hypoglycemia had lower interstitial glucose (median, 25?75 percentile: 7.0, 6.4?8.3 vs. 8.3, 7.4?8.5 mmol/l, p=0.01) and higher glucose variability (2.5, 1.9?3.1 vs. 1.8, 1.4?2.2 mmol/l, respectively; p=0.0008). There was no significant difference between the groups regarding daily insulin dose, HbA1c or T2DM duration. In a model of stepwise discriminant analysis, age, duration of insulin therapy, mean interstitial glucose levels and glycemic variability showed associations with hypoglycemia (accuracy rate 97.5%, p=0.005).
Conclusion.
The unrecognized hypoglycemia is a common complication in elderly T2DM patients on insulin therapy. Compared to conventional blood glucose monitoring, two-day CGM is superior in detection of asymptomatic hypoglycemia in this patient group. Age, duration of insulin therapy, mean glucose levels and glucose variability were associated with hypoglycemic events in elderly patients with T2DM.
About the Authors
Vadim Valer'evich Klimontov
Institute of Clinical and Experimental Lymphology, Novosibirsk
Russian Federation
MD, PhD, Hed of the Endocrinology laboratory
Russian Federation
MD, PhD, Hed of the Endocrinology laboratory
Alexander Ivanovich Tsiberkin
Institute of Clinical and Experimental Lymphology, Novosibirsk
Russian Federation
Assistant, Endocrinology laboratory
Russian Federation
Assistant, Endocrinology laboratory
Olga Nikolaevna Fazullina
Institute of Clinical and Experimental Lymphology, Novosibirsk
Russian Federation
Junior Researcher, Endocrinology laboratory
Russian Federation
Junior Researcher, Endocrinology laboratory
Marina Alekseevna Prudnikova
Institute of Clinical and Experimental Lymphology, Novosibirsk
Russian Federation
Junior Researcher, Endocrinology laboratory
Russian Federation
Junior Researcher, Endocrinology laboratory
Nadezhda Viktorovna Tyan
Institute of Clinical and Experimental Lymphology, Novosibirsk
Russian Federation
Junior Researcher, Endocrinology laboratory
Russian Federation
Junior Researcher, Endocrinology laboratory
Vladimir Iosifovich Konenkov
Institute of Clinical and Experimental Lymphology, Novosibirsk
Russian Federation
MD, PhD, Professor, fellow of russian Academy of Sciences, Head of Institute
Russian Federation
MD, PhD, Professor, fellow of russian Academy of Sciences, Head of Institute
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For citations:
Klimontov V.V., Tsiberkin A.I., Fazullina O.N., Prudnikova M.A., Tyan N.V., Konenkov V.I. Hypoglycemia in type 2 diabetes patients treated with insulin: the advantages of continuous glucose monitoring. Diabetes mellitus. 2014;17(1):75-80. (In Russ.) https://doi.org/10.14341/DM2014175-80
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