A Probabilistic Model for Predicting Hypoglycemia in Type 2 Diabetes Mellitus

Murata, Glen H.; Hoffman, Richard M.; Shah, Jayendra H.; Wendel, Christopher; Duckworth, William C.

doi:10.1001/archinte.164.13.1445

Cited by 74 publications

(43 citation statements)

References 16 publications

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“…Similarly, poorer b-cell function on OGTT was associated with increased glycemic variability in participants spanning the spectrum of glucose tolerance from normal to prediabetes to T2DM (19). Finally, this relationship is further supported by evidence that increased glycemic variability (rather than the absolute level of glycemia) may be an important determinant of the risk of hypoglycemia, implicating diminished capacity of the b-cells (or islets) to regulate glucose levels from straying either above or below the normal range (14)(15)(16). Against this background, the current study extends this literature by demonstrating that glycemic variability in early T2DM is modifiable and can be reduced by improving b-cell function with short-term IIT.…”

Section: Discussionmentioning

confidence: 83%

“…However, although some studies have reported that increased glycemic variability may be associated with the incidence of diabetic retinopathy (6,7), diabetic neuropathy (8), and coronary artery calcification (9) in patients with T2DM and type 1 diabetes (T1DM), other studies have not supported this association (10)(11)(12). Nevertheless, although its relevance to vascular complications remains uncertain (13), at a given level of glycemia, increased glucose variability raises the risk of hypoglycemia (14)(15)(16) and, hence, is clinically important.…”

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confidence: 99%

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Glycemic Variability in Patients With Early Type 2 Diabetes: The Impact of Improvement in β-Cell Function

et al. 2014

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OBJECTIVEIncreased glycemic variability has been reported to be associated with the risk of hypoglycemia and possibly diabetes complications and is believed to be due to b-cell dysfunction. However, it is not known whether improvement in b-cell function can reduce glycemic variability. Because short-term intensive insulin therapy (IIT) can improve b-cell function in early type 2 diabetes (T2DM), our objective was to determine whether the b-cell functional recovery induced by this therapy is associated with decreased glycemic variability. RESEARCH DESIGN AND METHODSSixty-one patients with T2DM of 3.0 years mean duration underwent 4 weeks of IIT, which consisted of basal insulin detemir and premeal insulin aspart. Glucose variability was assessed in both the first and the last week by the coefficient of variation of capillary glucose on daily 6-point self-monitoring profiles. b-Cell function before and after IIT was assessed with the Insulin Secretion-Sensitivity Index-2 (ISSI-2). RESULTSBetween the first and the last week on IIT, 55.7% of patients had a reduction in glucose variability. Change in glucose variability was negatively correlated with the change in b-cell function (ISSI-2) (r = 20.34, P = 0.008). On multiple linear regression analyses, percentage change in ISSI-2 emerged as the only factor independently associated with the change in glucose variability (standardized b = 20.42, P = 0.03). Moreover, patients with an increase in ISSI-2 ‡25% experienced a reduction in glucose variability compared with their peers who had almost no change (20.041 6 0.06 vs. 20.0002 6 0.04, respectively; P = 0.006). CONCLUSIONSIn early T2DM, glycemic variability is a modifiable parameter that can be reduced by improving b-cell function with short-term IIT.

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Section: Discussionmentioning

confidence: 83%

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confidence: 99%

Glycemic Variability in Patients With Early Type 2 Diabetes: The Impact of Improvement in β-Cell Function

et al. 2014

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“…Diyabetik diyaliz hastalarında, yüksek HbA1c ve uzun dönem glisemik dalgalanmalar hipoglisemi ile ilişkili hastaneye yatış riskinde artışa neden olmaktadır. 25 Williams ve ark.nın yaptıkları çalışmada HD tedavisine yeni başlayan diyabetik hastalar üç yıl boyunca takip edilmiş ve hipoglisemi nedeni ile hastaneye yatan hastaların oranı %4,1 olarak bulunurken, HbA1c düzeyi arttıkça hipoglisemiye bağlı hastaneye yatış riskinde artış saptanmıştır. Üç yıllık HbA1c takipleri sonucunda HbA1c dü-zeyi arttıkça SD'nin arttığı ve SD'deki artışın da hipoglisemiye bağlı hastaneye yatış riskini artır-dığı gösterilmiştir.…”

Section: Gli̇semi̇k Dalgalanma Ve Di̇yabeti̇k Kompli̇kasyon İli̇şki̇si̇unclassified

Glycemic Variability and Hemodialysis

Baştürk¹,

Koç²,

Hasbal³

et al. 2016

Turkiye Klinikleri J Intern Med

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“…Both Cox, et al and The Diabetes Outcome in Veterans Study (DOVES) suggested that glycemic variability may be a potential predictor of future hypoglycemia occurrence. 48,49 Furthermore, glycemic variability if accompanied with severe hypoglycemia episodes may adversely alter the prognosis of acutely ill patients 50,51 It has also been shown that hyperglycemia after hypoglycemia could be more hazardous than that when hypoglycemia is followed by normoglycemia. 52 One can argue that much of risk in long-term microvascular and macrovascular complications could be avoided by focusing merely in reduction of hypoglycemic episodes.…”

Section: Glycemic Variability and Hypoglycemia Complica-tionsmentioning

confidence: 99%

Glycemic Variability: Clinical and Prognostic Significance

Yu¹,

Lin²,

Huang³

et al. 2015

Diabetes Res Open J

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Minimizing development or progression of chronic diabetic micro and macro-vascular complications has been always the goal of glycemic control. In recent years, much attention has been focused on the possibility that glycemic variability confers an additional risk factor for diabetic complications independent of glycated hemoglobin (HbA1c). Evidence suggests that fluctuating glucose levels produce endothelial dysfunction as well as an increase in free radicals, the key link between hyperglycemia and diabetic complications and that these changes are greater than those produced by sustained hyperglycemia in in vitro and in animal studies. In humans studies, experimental setting also support the hypothesis that plasma glucose fluctuations produce a higher increase in oxidative stress as well as endothelial dysfunction than those produced by sustained hyperglycemia in type 2 diabetes. Moreover, glycemic variability may have a role in the prediction of severe hypoglycemia, which may act as a precipitating factor of diabetic complications. Based on review of available evidence, we advocate decreasing hyperglycemia and diminishing glycemic variability as well as avoiding hypoglycemia in diabetic patients as targets of diabetic therapy. Future trials targeting the influence of the control of plasma glucose fluctuations on the development of diabetic micro-and macro-vascular complications are needed to further strengthen the evidence base.

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A Probabilistic Model for Predicting Hypoglycemia in Type 2 Diabetes Mellitus

Abstract: Self-monitoring of blood glucose is superior to hemoglobin A1c measurement in predicting long-term hypoglycemia in persons with type 2 diabetes. The risk of hypoglycemia associated with treatment intensification may be offset by strategies that reduce glucose variability.

Cited by 74 publications

References 16 publications

Glycemic Variability in Patients With Early Type 2 Diabetes: The Impact of Improvement in β-Cell Function

Glycemic Variability in Patients With Early Type 2 Diabetes: The Impact of Improvement in β-Cell Function

Glycemic Variability and Hemodialysis

Glycemic Variability: Clinical and Prognostic Significance

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