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Diabetes Obes Metab. 2019 Mar;21(3):622-630. doi: 10.1111/dom.13565. Epub 2018 Nov 26.

Day-to-day fasting self-monitored blood glucose variability is associated with risk of hypoglycaemia in insulin-treated patients with type 1 and type 2 diabetes: A post hoc analysis of the SWITCH Trials.

Author information

1
University of Amsterdam, Amsterdam, The Netherlands.
2
Profil Institute for Metabolic Research, Neuss, Germany.
3
AMCR Institute, Escondido, California.
4
Iowa Diabetes and Endocrinology Research Center, Des Moines, Iowa.
5
Albany Medical College, Albany, New York.
6
Medical University of Silesia, Katowice, Poland.
7
University of Sheffield, Sheffield, UK.
8
Mountain Diabetes and Endocrine Center, Asheville, North Carolina.
9
Rockwood Clinic, Spokane, Washington.
10
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
11
Novo Nordisk A/S, Søborg, Denmark.
12
Scripps Whittier Diabetes Institute, San Diego, California.

Abstract

AIMS:

To investigate the association between day-to-day fasting self-monitored blood glucose (SMBG) variability and risk of hypoglycaemia in type 1 (T1D) and type 2 diabetes (T2D), and to compare day-to-day fasting SMBG variability between treatments with insulin degludec (degludec) and insulin glargine 100 units/mL (glargine U100).

MATERIALS AND METHODS:

Data were retrieved from two double-blind, randomized, treat-to-target, two-period (32 weeks each) crossover trials of degludec vs glargine U100 in T1D (SWITCH 1, n = 501) and T2D (SWITCH 2, n = 720). Available fasting SMBGs were used to determine the standard deviation (SD) of day-to-day fasting SMBG variability for each patient and the treatment combination. The association between day-to-day fasting SMBG variability and overall symptomatic, nocturnal symptomatic and severe hypoglycaemia was analysed for the pooled population using linear regression, with fasting SMBG variability included as a three-level factor defined by population tertiles. Finally, day-to-day fasting SMBG variability was compared between treatments.

RESULTS:

Linear regression showed that day-to-day fasting SMBG variability was significantly associated with overall symptomatic, nocturnal symptomatic and severe hypoglycaemia risk in T1D and T2D (P < 0.05). Day-to-day fasting SMBG variability was significantly associated (P < 0.01) with all categories of hypoglycaemia risk, with the exception of severe hypoglycaemia in T2D when analysed within tertiles. Degludec was associated with 4% lower day-to-day fasting SMBG variability than glargine U100 in T1D (P = 0.0082) and with 10% lower day-to-day fasting SMBG variability in T2D (P < 0.0001).

CONCLUSIONS:

Higher day-to-day fasting SMBG variability is associated with an increased risk of overall symptomatic, nocturnal symptomatic and severe hypoglycaemia. Degludec has significantly lower day-to-day fasting SMBG variability vs glargine U100.

KEYWORDS:

basal insulin; hypoglycaemia; insulin therapy; type 1 diabetes; type 2 diabetes

PMID:
30362250
DOI:
10.1111/dom.13565

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