Continuous Glucose Monitoring for the Detection of Hypoglycemia in Patients With Diabetes of the Exocrine Pancreas

Abstract

Background: Detailed evaluations of hypoglycemia and associated indices based on continuous glucose monitoring (CGM) are limited in patients with diabetes of the exocrine pancreas. Our study sought to evaluate the frequency and pattern of hypoglycemic events and to investigate hypoglycemia-specific indices in this population. Methods: This was a cross-sectional study comprising 83 participants with diabetes of the exocrine pancreas. CGM and self-monitoring of blood glucose (SMBG) were performed on all participants for a minimum period of 72 hours. The frequency and pattern of hypoglycemic events, as well as hypoglycemia-related indices, were evaluated. Results: Hypoglycemia was detected in 90.4% of patients using CGM and 38.5% of patients using SMBG. Nocturnal hypoglycemic events were more frequent (1.9 episodes/patient) and prolonged (142 minutes) compared with day-time events (1.1 episodes/patient; 82.8 minutes, P < 0.05). The mean low blood glucose index was 2.1, and glycemic risk assessment diabetes equation hypoglycemia was 9.1%. The mean time spent below (TSB) <70 mg/dL was 9.2%, and TSB <54 mg/dL was 3.7%. The mean area under curve (AUC) <70 mg/dL was 1.7 ± 2.5 mg/dL/hour and AUC <54 mg/dL was 0.6 ± 1.3 mg/dL/hour. All of the CGM-derived hypoglycemic indices were significantly more deranged at night compared with during the day ( P < 0.05). Conclusion: Patients with diabetes of the exocrine pancreas have a high frequency of hypoglycemic episodes that are predominantly nocturnal. CGM is superior to SMBG in the detection of nocturnal and asymptomatic hypoglycemic episodes. CGM-derived hypoglycemic indices are beneficial in estimating the risk of hypoglycemia.

The spectrum of diabetes in acute and chronic pancreatitis

“…‘brittle diabetes’) [7]. A recent pilot study based on continuous glucose monitoring supports this concern [30].…”

Distinguishing diabetes secondary to pancreatic diseases from type 2 diabetes mellitus

“…Additionally, several retrospective studies in the 1970s suggested that diabetes secondary to pancreatic diseases is characterized by a more unstable (i.e., ‘brittle’) pattern of glycemic control [18,19]. A modern study using continuous glucose monitoring found that 90% of people with diabetes secondary to pancreatic disease experienced an episode of hypoglycemia (of whom 29% had symptoms) [20]. The study also reported that the period between 3 a.m. and 6 a.m. was the most common time for hypoglycemia in this setting.…”

Digital health and diabetes: experience from India

“…21 The authors of a cross-sectional study evaluated the superiority of CGM-derived hypoglycemic indices to identify nocturnal and asymptomatic hypoglycemic episodes in 83 PwD of the exocrine pancreas. 22 Another study comprising 5901 patients with T2D used CGM to find the association between AGP indicators and diabetes-related complications. The results indicated that those with both the hypo and hyper profiles, which can only be detected by CGM, had a higher risk of non-proliferative diabetic retinopathy (NPDR), macroalbuminuria, and diabetic kidney disease.…”