We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Impact of insulin initiation on glycaemic variability and glucose profiles in a primary healthcare Type 2 diabetes cohort: analysis of continuous glucose monitoring data from the INITIATION study.
- Authors
Manski‐Nankervis, J.; Yates, C. J.; Blackberry, I.; Furler, J.; Ginnivan, L.; Cohen, N.; Jenkins, A.; Vasanthakumar, S.; Gorelik, A.; Young, D.; Best, J.; O'Neal, D.
- Abstract
Aim To use continuous glucose monitoring to examine the effects of insulin initiation with glargine, with or without glulisine, on glycaemic variability and glycaemia in a cohort of people with Type 2 diabetes receiving maximum oral hypoglycaemic agents in primary healthcare. Methods We conducted a post hoc analysis of continuous glucose monitoring data from 89 participants at baseline and at 24 weeks after insulin commencement. Indicators of glycaemic variability (standard deviation, J-index and mean amplitude of glycaemic excursion) and glycaemia (HbA1c, mean glucose, area under the glucose-time curve) were assessed. Multi-level regression analysis was used to identify the predictors of change. Results Complete glycaemic variability data were available for 78 participants. Of these participants, 41% were women, their mean ( sd) age was 59.2 (10.4) years, the median (interquartile range) diabetes duration was 10.4 (6.5, 13.3) years and the median (interquartile range) baseline HbA1c was 82.5 (71.6, 96.7) mmol/mol [9.7 (8.7, 11.0)%]. At baseline, BMI correlated negatively with standard deviation ( r = −0.30) and mean amplitude of glycaemic excursion ( r = −0.26), but not with J-index; HbA1c correlated with J-index ( r = 0.61) but not with mean amplitude of glycaemic excursion and standard deviation. After insulin initiation the mean ( sd) glucose level decreased [from 12.0 (3.0) to 8.5 (1.6) mmol/l; P < 0.001], as did the median (interquartile range) J-index [from 66.9 (47.7, 95.1) to 36.9 (27.6, 49.8) mmol/l; P < 0.001]. Baseline HbA1c correlated with a greater J-index reduction ( r = −0.45; P < 0.001). The mean amplitude of glycaemic excursion and standard deviation values were unchanged. The baseline temporal profile, showing elevated postprandial morning glucose levels, was unchanged after insulin initiation, despite an overall reduction in glycaemia. Conclusion Insulin initiation reduced hyperglycaemia but did not alter glycaemic variability in adults with Type 2 diabetes receiving maximum oral hypoglycaemic agents. The most significant postprandial excursions were seen in the morning, which identifies prebreakfast as the most effective target for short-acting insulin therapy.
- Subjects
BLOOD sugar analysis; HYPOGLYCEMIA; TYPE 2 diabetes diagnosis; BLOOD sugar monitoring; TYPE 2 diabetes complications; CONFIDENCE intervals; PEOPLE with diabetes; ETHICS; GLYCOSYLATED hemoglobin; HYPOGLYCEMIC agents; INSULIN; TYPE 2 diabetes; ORAL drug administration; PRIMARY health care; RESEARCH funding; DATA analysis; BODY mass index; METFORMIN; GLYCEMIC control; DIAGNOSIS
- Publication
Diabetic Medicine, 2016, Vol 33, Issue 6, p803
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/dme.12979