Rate of hypoglycemia in insulin-treated patients with type 2 diabetes can be predicted from glycemic variability data
Abstract
BACKGROUND: We set out to study the relationship between different measures of glycemic variability and the rate of hypoglycemia in patients with type 2 diabetes. SUBJECTS AND METHODS: Data were pooled from three 24-week insulin trials including patients on twice-daily (BID) insulin lispro mix 75/25 (75% insulin lispro protamine suspension, 25% insulin lispro) (n=805), daily (QD) insulin glargine (n=1,019), insulin lispro protamine suspension (n=353) (QD or BID), and insulin detemir (n=166) (QD or BID), all with continuation of prestudy oral antihyperglycemic medications. Glycemic variability measures were derived from seven-point self-monitored blood glucose profiles. RESULTS: At baseline, mean (±SD) age was 56.9±9.7 years, duration of type 2 diabetes was 9.5±6.1 years, hemoglobin A1c (HbA1c) was 8.9±1.1%, and 51.9% were male. Intra-day glucose coefficient of variation (CV), fasting blood glucose, intra-day minimum glucose and inter-day glucose CV at 24 weeks, and intra-day glucose CV at baseline were significantly correlated with the rate of hypoglycemia events between Weeks 12 to 24 (P<0.05 for all measures). CONCLUSIONS: Intra-day and inter-day glycemic variability is significantly associated with the risk of hypoglycemia in insulin-treated patients with type 2 diabetes, even after adjusting for mean glucose and HbA1c. The intra-day glycemic variability before starting insulin is significantly associated with the risk of hypoglycemia during insulin treatment, which points at treatment- and patient-related factors mediating this relationship.
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Certain conditions such as anemia, hemoglobinopathies, iron deficiency, and pregnancy can confound A1C measurements.
“Moreover, certain conditions such as anemia (36), hemoglobinopathies (37), iron deficiency (38), and pregnancy (39) can confound A1C measurements.”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [36]
Glycemic variability is associated with increased risk of hypoglycemia in patients with diabetes, independently of glycated hemoglobin level.
“Recent clinical data indicate that GV is associated with increased risk of hypoglycemia, microvascular and macrovascular complications, and mortality in patients with diabetes, independently of glycated hemoglobin level.”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [14]
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- Authors
- Qu, Y., Jacober, S. J., Zhang, Q., Wolka, L. L., & DeVries, J. H.
- Affiliations
- Eli Lilly (United States) (US)
- University of Amsterdam (NL)
- Corresponding author
- DeVries, J. Hans
- Venue
- Diabetes Technology & Therapeutics
- Publisher
- SAGE Publications
- Published
- 2012-11
- Volume
- 14
- Issue
- 11
- Pages
- 1008-1012
- ISSN
- 1520-9156 (ISSN-L)
- 1557-8593
- OpenAlex
- W2059534220
- Cited by
- 126
- References
- 15
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 9 · 2021: 8 · 2020: 15 · 2019: 11 · 2018: 14 · 2017: 14 · 2016: 4 · 2015: 12 · 2014: 9 · 2013: 10 · 2012: 1
- FWCI
- 8.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Technology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- hypoglycemia, glycemic variability, type 2 diabetes, insulin therapy, insulin lispro, insulin glargine, insulin detemir, coefficient of variation, self-monitoring of blood glucose, hypoglycemia risk prediction, HbA1c
- MeSH terms
- Analysis of Variance, Blood Glucose, Diabetes Mellitus, Type 2, Fasting, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Predictive Value of Tests, Risk Assessment
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