Glycemic variability in patients with type 1 diabetes mellitus with different types of insulin therapy

• Anna R. Volkova
• Maria E. Chernaya
• Anna V. Lisker
• Sokolova Mariia N.
• Fedulova Zhanna V.

Abstract

The aim - to evaluate glycemic variability (GV) in patients with type 1 diabetes mellitus (T1DM) during therapy by multiple insulin injections (MII) and continuous subcutaneous insulin infusion (CSII) in order to optimisation intensive insulin therapy in patients with T1DM.

Results and discussion. The study included 23 patients with T1DM in insulin therapy by MII and 23 patients with T1DM in insulin therapy by CSII. GV in patients with T1DM were significantly different from the normal GV rates for healthy people. Indexes of GV for patients with T1DM require further study in large cohorts of patients in order to determine thetarget values of GV averages for patients with diabetes mellitus. There are no statistically significant differences in the rates of GV between patients on therapy by MII and CSII.

Conclusions. Most of the sampled patients with T1DM - 82.6% in group CSII and 87% in group MII, - haven't got target glycated haemoglobin values. GV indexes in both groups whatever the type of insulin therapy was significantly higher than normal rates for healthy people. Using CSII doesn't give benefits in glycemic control compared with insulin therapy by MII without quality patient education. It is necessary to educate patients on the use advanced capabilities of insulin pump in order to achieve better glycemic control.

Keywords:diabetes mellitus, continuous glucose monitoring, glycemic variability, pumpinsulin therapy

References

1. Ametov A.S., Pugovkina Ya.V., Chernikova N.A. Glucose homeostasis in a healthy person under different conditions. The modern view. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2016; 5 (1): 45-55. (in Russian)

2. Dreval’ A.V., Kovaleva Yu.A., Starostina E.G. Comparative characteristics of continuous glycemic curve in patients with type 1 and type 2 diabetes mellitus. Lechashchiy vrach [Attending Physician]. 2011; (11): 50. (in Russian)

3. Esposito K., et al. Infl ammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation. 2002; 106 (16): 2067-72.

4. Hirsch I.B. Glycemic variability and diabetes complications: does it matter? Of course it does! Diabetes Care. 2015; 38 (8): 1610-4.

5. Paneni F., Costantino S., Cosentino F. Molecular mechanisms of vascular dysfunction and cardiovascular biomarkers in type 2 diabetes. Cardiovasc Diagn Ther. 2014; 4 (4): 324-32.

6. Coutinho M., et al. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. 1999; 22 (2): 233-40.

7. Suh S., Kim J.H. Glycemic variability: how do we measure it and why is it important? Diabetes Metab J. 2015; 39 (4): 273-82.

8. Kilpatrick E.S., et al. Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetes. Diabetologia. 2007; 50 (12): 2553-61.

9. Cryer P.E. Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia. Diabetes. 2014; 63 (7): 2188-95.

10. Kovatchev B., Cobelli C. Glucose variability: timing, risk analysis, and relationship to hypoglycemia in diabetes. Diabetes Care. 2016; 39 (4): 502-10.

11. Klimontov V.V., Myakina N.E. Variability of glycemia in diabetes mellitus: a tool for assessing the quality of glycemic control and risk of complications. Sakharniy diabet [Diabetes Mellitus]. 2014; (2): 76-82 (in Russian).

12. Klimontov V.V., Myakina N.E. Variability of Glycemia in Diabetes Mellitus: Monograph. 2nd ed. correct. and suppl. Novosibirsk: IPTs NGU, 2018: 246 p. (in Russian)

13. Dedov I.I., Shestakova M.V., et al. Diabetes mellitus in the Russian Federation: prevalence, morbidity, mortality, parameters of carbohydrate metabolism and structure of hypoglycemic therapy according to the Federal register of diabetes mellitus, status 2017. Sakharniy diabet [Diabetes Mellitus]. 2018; 21 (3): 144-59. (in Russian)

14. Vivian A. Fonseca, Grunberger G., et al. Glucose monitoring consensus. Endocr Pract. 2016; 22 (8): 1008-21.

15. Hill N.R., Oliver N.S., et al. Normal reference range for mean tissue glucose and glycemic variability derived from continuous glucose monitoring for subjects without diabetes in different ethnic groups. Diabetes Technol Ther. 2011; 13 (9): 921-8.

16. Nomura K., Saitoh T., et al. Glycemic profiles of healthy individuals with low fasting plasma glucose and HbA1c. International Scholarly Research Network. ISRN Endocrinol. 2011; 2011: 435047.

17. Mazze R.S., Strock E., et al. Characterizing glucose exposure for individuals with normal glucose tolerance using continuous glucose monitoring and ambulatory glucose profile analysis. Diabetes Technol Ther. 2008; 10: 149-59.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)