Major Increases between Pre- and Post-breakfast Glucose Levels May Predict Nocturnal Hypoglycemia in Type 2 Diabetes

Abstract

Objective The aim of this study was to determine whether nocturnal hypoglycemia may be predicted according to morning glucose levels. Methods We retrospectively evaluated 106 patients with type 2 diabetes who underwent continuous glucose monitoring during admission. The pre-breakfast glucose level (Pre-breakfast level), highest postprandial glucose level within 3 hours after breakfast (Highest level), time from the start of breakfast to the highest postprandial glucose level (Highest time), difference between the pre-breakfast and highest postprandial breakfast glucose levels (Increase), area under the glucose curve (≥180 mg/dL) within 3 hours after breakfast (Morning AUC), post-breakfast glucose gradient (Gradient), and the increase-to-pre-breakfast ratio (Increase/Pre-breakfast) were calculated. The subjects were divided into hypoglycemic and non-hypoglycemic patients and compared for the above parameters using the t-test. A receiver operating characteristic analysis was used to determine the optimal cut-off values to predict nocturnal hypoglycemia (Hypoglycemia). Results Twenty-eight patients (26.4%) had hypoglycemia. The Pre-breakfast levels were significantly lower in patients with hypoglycemia than those without (p=0.03). The Increases were significantly higher in patients with hypoglycemia than those without (p=0.047). The Increase/Pre-breakfast ratio were significantly larger in patients with hypoglycemia than those without (p=0.0002). Their cut-off values were as follows (level, sensitivity, specificity, and area under the curve): 123 mg/dL, 0.89, 0.55, and 0.78 (p<0.0001); 90.5 mg/dL, 0.75, 0.64, and 0.76 (p<0.0001); and 90.2%, 0.75, 0.76, and 0.78 (p<0.0001), respectively. Conclusion Major increases between the pre- and post-breakfast glucose levels may predict nocturnal hypoglycemia in patients with type 2 diabetes.

Are glucose profiles well-controlled within the targets recommended by the International diabetes Federation in type 2 diabetes? A meta-analysis of results from continuous glucose monitoring based studies

“…Mean differences between post-breakfast glucose spike, post-lunch glucose spike and post-dinner glucose spike and the IDF target (≤2.5 mmol/L) were also meta-analysed. The standard errors used in meta-analysis were calculated from standard deviations [6][7][8][9][10][11][12][13][14] and interquartile ranges [4] for each study [15][16][17]. The standard errors for the IDF target values were substituted with zero [18].…”

“…Twelve observational (eight cross-sectional, two longitudinal, one prospective and one retrospective) studies investigating fasting glucose, pre-meal glucose and postprandial glucose by CGM were included. Participants with known type 2 diabetes for 1.7 years [4] [10] were respectively used in eight studies. One study included newly diagnosed type 2 diabetes [8], and three studies did not report the sample's duration of diabetes [13,14,16].…”

“…Total 731 people from twelve observational studies were included in this meta-analysis, and fasting glucose, pre-breakfast glucose, pre-dinner glucose, postprandial glucose after breakfast, postprandial glucose after lunch, postprandial glucose after dinner and HbA1c data were respectively obtained from 619, 410, 410, 645, 476, 476 and 731 people. Participants were taking different anti-diabetes agents (metformin, sulphonylurea, thiazolidinedione, α-glucosidase inhibitor, dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 receptor agonist, sodium-glucose cotransporter 2 inhibitor, glinides and insulin) [6][7][8][9][10][11][12][13]15,16]. Participants with diet management were included in four studies [4,12,14,16].…”

“…The study objectives stated were to evaluate glucose profiles [4][5][6][7][8][9][10]13,15,16] and associations of HbA1c with glucose profiles [11,12,14]. Fasting glucose (pre-breakfast glucose) in ten studies [4,[7][8][9][10][11][13][14][15][16] and pre-lunch and pre-dinner glucose in four studies [4,8,11,16] were reported.…”

Comparison of tofogliflozin 20 mg and ipragliflozin 50 mg used together with insulin glargine 300 U/mL using continuous glucose monitoring (CGM): A randomized crossover study

“…Large clinical studies have shown that hypoglycemia and glycemic variability are associated with mortality in patients with diabetes mellitus [3][4][5]. We wanted to predict the Somogyi phenomenon, in which hypoglycemia and increased glycemic variability occur concomitantly, and we have previously reported that major increases between pre-and post-breakfast glucose levels may predict nocturnal hypoglycemia in type 2 diabetes [6].…”