Endocrine Abstracts

Introduction: Assessment of diabetes with daily blood glucose fluctuations including peaks and nadirs forms the crux of the modern management. Use of glycemic variability (GV) as a parameter to assess these fluctuations is emerging. Diabetes mellitus patients follow different clinical trajectories which can be traced by the ambulatory glucose profile (AGP) obtained from flash glucose monitoring system (FGMS).

Methodology: This comparative observational study enrolled 106 adult (>18 years) type 2 diabetes patients with HbA1c<8% from a tertiary care hospital in India. Patients were divided into two groups (group A & group B) with 53 patients each. Group A included patients on OAD’s with insulin and Group B included patients on OAD’s without insulin. The patients were put on FGMS for 14 days and their AGP was analysed. Indices of glycemic variability like Mean, MAGE (Mean amplitude of glycemic excursion), SD (Standard deviation), COV (Coefficient of variation), time in target (TIT), time above target (TAT), time below target (TBT), MODD (Mean of daily differences) were computed using Mann Whitney test.

Results: Median (25th-75th percentile) of glycemic variability parameters - Mean(mg/dl), MAGE(mg/dl), SD(mg/dl), time above target(%), MODD in group A {Insulin} was {139, 145, 44.68, 40, 38.47} respectively which was significantly higher as compared to group B{OAD} {111, 123, 33.31, 18, 26.31} respectively (P<0.05). Time in target (%) depicting time in glucose range of 70–180 mg/dl and time below target was achieved more with group B{OAD} (54% & 12% ) as compared with group A {Insulin} (39% & 7%) respectively (P<0.05). No significant difference was found for COV between the groups. Amongst the OAD’s used in patients taking insulin {group A}, glycemic variability was higher with sulfonylurea as compared with DPP-4 inhibitors for the parameter of mean(mg/dl) and MODD (217.5 & 52.4 vs 126.5 & 31.38 respectively). DPP-4 inhibitors achieved higher time in target (53%) as compared with sulfonylurea (11%) (P<0.005). No significant difference in glycemic variability was found in subgroup analysis of group B (OAD) in our study. Group A patients had significantly higher (29.99%) total number of hyperglycemic episodes than with group B (9.08%) (p value<0.0001).

Conclusion: Our study showed that the glycemic variability was found to be significantly higher in patients taking OAD’s with insulin (group A) as compared with patients who were taking OAD’s without insulin (group B). DPP-4 inhibitor was found to achieve more time in target range with less glycemic variability as compared with sulfonylurea.