Reduced Glucose Variability With Glucose-Dependent Versus Glucose-Independent Therapies Despite Similar Glucose Control and Hypoglycemia Rates in a Randomized, Controlled Study of Older Patients With Type 2 Diabetes Mellitus.
Reduced Glucose Variability With Glucose-Dependent Versus Glucose-Independent Therapies Despite Similar Glucose Control and Hypoglycemia Rates in a Randomized, Controlled Study of Older Patients With Type 2 Diabetes Mellitus.
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DOI：
10.1177/1932296818776993
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发表时间：
2018-11
影响因子：
5
通讯作者：
Festa A
中科院分区：
文献类型：
--
作者：
Pratley RE;Rosenstock J;Heller SR;Sinclair A;Heine RJ;Kiljański J;Brusko CS;Duan R;Festa A
很少有研究评价了未使用注射治疗的2型糖尿病（T2 DM）老年患者的动态血糖监测（CGM）。CGM可用于研究与T2 DM并发症相关的低血糖和血糖变异性。进行了一项CGM子研究：2型糖尿病老年患者个体化治疗方法的随机试验（IMPERIUM）。患者为易感（中度疾病和/或虚弱）老年（≥65岁）T2 DM控制欠佳的个体。策略A包括葡萄糖依赖性治疗（n = 26），非磺酰脲类口服降糖药（OAM）和胰高血糖素样肽-1受体激动剂作为第一次注射。策略B包括非葡萄糖依赖性治疗（n = 21），磺酰脲类药物作为首选OAM，甘精胰岛素作为首次注射剂。主要终点为第24周24小时内血糖（BG）≤70 mg/dL的持续时间和时间百分比。对于策略A和策略B，≤70 mg/dL低血糖的持续时间和时间百分比相似;两组的血糖控制改善相似（第24周HbA 1c变化的LSM; A = − 1.2%，B = −1.4%）。两组中，持续时间和持续时间百分比与正常血糖和高血糖相似。然而，策略A与第24周时较低的日内（21.1 ± 1.2 vs 25.1 ± 1.4，P = 0.046）和日间（5.4 ± 1.0 vs 9.1 ± 1.3，P = 0.038）BG变异性（变异系数[LSM ± SE]）相关。这项在老年T2 DM患者中进行的CGM子研究显示，使用葡萄糖依赖性治疗的日内和日间BG变异性较低，但使用葡萄糖非依赖性策略的HbA 1c降低和低血糖持续时间相似。
Few studies have evaluated continuous glucose monitoring (CGM) in older patients with type 2 diabetes mellitus (T2DM) not using injectable therapy. CGM is useful for investigating hypoglycemia and glycemic variability, which is associated with complications in T2DM. A CGM substudy of Individualized treatMent aPproach for oldER patIents in a randomized trial in type 2 diabetes Mellitus (IMPERIUM)) was conducted. Patients were vulnerable (moderately ill and/or frail) older (≥65 years) individuals with suboptimally controlled T2DM. Strategy A comprised glucose-dependent therapies (n = 26) with a nonsulfonylurea oral antihyperglycemic medication (OAM) and a glucagon-like peptide-1 receptor agonist as the first injectable. Strategy B comprised non-glucose-dependent therapies (n = 21) with sulfonylurea as the preferred OAM and insulin glargine as the first injectable. Primary endpoints were duration and percentage of time spent with blood glucose (BG) ≤70 mg/dL over 24 hours at week 24. Duration and percentage of time spent with hypoglycemia at ≤70 mg/dL were similar for Strategy A and Strategy B; glycemic control improved similarly in both arms (LSM change in HbA1c at week 24; A = −1.2%, B = −1.4%). Duration and percentage time spent with euglycemia and hyperglycemia were also similar in both arms. However, Strategy A was associated with lower within-day (21.1 ± 1.2 vs 25.1 ± 1.4, P = .046) and between-day (5.4 ± 1.0 vs 9.1 ± 1.3, P = .038) BG variability (coefficient of variance [LSM ± SE]) at week 24. This CGM substudy in older patients with T2DM showed lower within- and between-day BG variability with glucose-dependent therapies but similar HbA1c reductions and hypoglycemia duration with glucose-independent strategies.