Glycemic variability and its responses to intensive insulin treatment in newly diagnosed type 2 diabetes

Abstract

Background: Recent data show that blood glucose (BG) variability is an HbA1c-independent risk factor for diabetic complications. This study investigated the characteristics of BG variability in type 2 diabetic patients and the effect of intensive treatment.

Material/methods: Forty-eight subjects with normal glucose regulation and 69 patients with newly diagnosed type 2 diabetes were monitored using the continuous glucose monitoring system. A subset of the type 2 diabetic patients (n=23) whose HbA1c was >8.5% was monitored a second time following 2 to 3 weeks of treatment with multiple daily injections. The mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), and the incremental areas above preprandial glucose values (AUCpp) were used for assessing intra-day, inter-day, and postprandial BG variability.

Results: In type 2 diabetic patients, the MAGE, MODD, and AUCpp levels were all higher than those of subjects with normal glucose regulation (P<0.001). Multivariant regression analysis indicated that AUCpp was the main independent factor influencing MAGE (Adjusted R2=0.56), while postprandial hyperglycemia was most prominent following breakfast and less evident during lunch and dinner. After intensive treatment, significant decreases in MAGE, MODD, and AUCpp were observed (41%, 29%, and 49%, respectively, P<0.001). AUCpp after breakfast was higher than after lunch and dinner (P<0.05). In 65.2% of the subjects, peak intra-day values occurred 103+/-30 minutes after breakfast.

Conclusions: Minimizing glycemic variability in type 2 diabetic patients, especially postprandial glucose excursions following breakfast, may be an important aspect of glucose management.