Can Fasting Glucose Levels or Post-Breakfast Glucose Fluctuations Predict the Occurrence of Nocturnal Asymptomatic Hypoglycemia in Type 1 Diabetic Patients Receiving Basal-Bolus Insulin Therapy with Long-Acting InsulinReportar como inadecuado




Can Fasting Glucose Levels or Post-Breakfast Glucose Fluctuations Predict the Occurrence of Nocturnal Asymptomatic Hypoglycemia in Type 1 Diabetic Patients Receiving Basal-Bolus Insulin Therapy with Long-Acting Insulin - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Objective

To investigate whether the occurrence of nocturnal asymptomatic hypoglycemia may be predicted based on fasting glucose levels and post-breakfast glucose fluctuations.

Patients and Methods

The study subjects comprised type 1 diabetic patients who underwent CGM assessments and received basal-bolus insulin therapy with long-acting insulin. The subjects were evaluated for I fasting glucose levels and II the range of post-breakfast glucose elevation from fasting glucose levels to postprandial 1- and 2-hour glucose levels. The patients were divided into those with asymptomatic hypoglycemia during nighttime and those without for comparison. Optimal cut-off values were also determined for relevant parameters that could predict nighttime hypoglycemia by using ROC analysis.

Results

64 patients mean HbA1c 8.7 ± 1.8% were available for analysis. Nocturnal asymptomatic hypoglycemia occurred in 23 patients 35.9%. Fasting glucose levels I were significantly lower in those with hypoglycemia than those without 118 ± 35 mg-dL vs. 179 ± 65 mg-dL; P < 0.001. The range of post-breakfast glucose elevation II was significantly greater in those with hypoglycemia than in those without postprandial 1-h, P = 0.003; postprandial 2-h, P = 0.005. The cut-off values determined for relevant factors were as follows: I fasting glucose level < 135 mg-dL sensitivity 0.73-specificity 0.83-AUC 0.79, P < 0.001; and II 1-h postprandial elevation > 54 mg-dL 0.65-0.61-0.71, P = 0.006, 2-h postprandial elevation > 78 mg-dL 0.65-0.73-0.71, P = 0.005.

Conclusions

Nocturnal asymptomatic hypoglycemia was associated with increases in post-breakfast glucose levels in type 1 diabetes. Study findings also suggest that fasting glucose levels and the range of post-breakfast glucose elevation could help predict the occurrence of nocturnal asymptomatic hypoglycemia.



Autor: Sumie Mitsuishi, Rimei Nishimura , Kiyotaka Ando, Daisuke Tsujino, Kazunori Utsunomiya

Fuente: http://plos.srce.hr/



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