Endocrine Abstracts

The routine approach to evaluating the effectiveness of diabetes treatment based on the level of glycated hemoglobin (HbA1c) accounts for the average glucose level but does not consider its fluctuations. However, recent data indicate that the development of late complications of diabetes is associated with the degree of variability in glycemia. (GV).

Clinical case: Patient F. is 54-year-old woman with a 33-year history of type 1 diabetes with multiple chronic complications: Diabetic autonomic neuropathy (unrecognized hypoglycemia). Diabetic sensorimotor polyneuropathy. Non-proliferative diabetic retinopathy. Diabetic nephropathy, CKD C2A1. There were frequent hypoglycemic episodes in the night and morning hours, including two unrecognized episodes requiring hospitalization. She tests her glycemia rarely, according to glucose meter from 1.7 to 14.0 mmol/l. But, the level of HbA1c from December 2017 is 7.3%. She received insulin therapy: insulin lispro 12 IU at 0800 h, 8 IU at 1800 h, insulin glargine 10 IU at 1000 h, 12 IU at 2200 h. Continuous glucose monitoring with the iPro-2 Medtronik (USA) system was carried out for a detailed study of glucose curves for 6 days. The increase in glycemia in the morning was recorded more than 22.2 mmol/l. Also episodes of lowering to 4.5–3.2 mmol/l, both clinically recognized and not recognized. Data analysis was carried out using the Easy GV calculator (v.9.0), proposed by N.Hill et al. We found a deviation in the parameters of GV: standard deviation SD 4.25 mmol/l (3,0), mean amplitude of glycemic excursions MAGE up to 5 mmol/l (2.8), lability index LI 5.85 (mmol/l)²/h (4.7), the continuous overlapping net glycemic action CONGA 11.39 mmol/l (5.5), the M-value index 31.21, which characterizes the “quality” of glycemic control. Therapy with long-acting insulin was started – glargin-300. The drug is chosen taking into account its longer period of action, gradual release from the subcutaneous fat, less variability of the action. The total dose of glargin-300 was 14 units (decreased by 8 units), GV during the day – from 6.5 to 13.0 mmol/l. Hypoglycemic episodes were not observed.

Conclusion: The choice of therapy taking into account the characteristics of GV allowed to achieve a decrease in the amplitude of fluctuation in glycemia, thus improving the long-term prognosis. Insulin glargin-300 may be the preferred drug in patients with type 1 diabetes and high GV, regardless of the level of HbA1c.