Oscillatory pattern of glycemic control in patients with diabetes mellitus

Abstract

Daily glucose variability is higher in diabetic mellitus (DM) patients which has been related to the severity of the disease. However, it is unclear whether glycemic variability displays a specific pattern oscillation or if it is completely random. Thus, to determine glycemic variability pattern, we measured and analyzed continuous glucose monitoring (CGM) data, in control subjects and patients with DM type-1 (T1D). CGM data was assessed for 6 days (day: 08:00–20:00-h; and night: 20:00–08:00-h). Participants (n = 172; age = 18–80 years) were assigned to T1D (n = 144, females = 65) and Control (i.e., healthy; n = 28, females = 22) groups. Anthropometry, pharmacologic treatments, glycosylated hemoglobin (HbA1c) and years of evolution were determined. T1D females displayed a higher glycemia at 10:00–14:00-h vs. T1D males and Control females. DM patients displays mainly stationary oscillations (deterministic), with circadian rhythm characteristics. The glycemia oscillated between 2 and 6 days. The predictive model of glycemia showed that it is possible to predict hyper and hypoglycemia (R2 = 0.94 and 0.98, respectively) in DM patients independent of their etiology. Our data showed that glycemic variability had a specific oscillation pattern with circadian characteristics, with episodes of hypoglycemia and hyperglycemia at day phases, which could help therapeutic action for this population.

A diabetic milieu increases ACE2 expression and cellular susceptibility to SARS-CoV-2 infections in human kidney organoids and patient cells

“…Diabetic patients exhibit oscillatory levels in glucose with daily episodes of hypo- and hyperglycemia, which is thought to be important for driving DM-associated pathologies ( Vasquez-Muñoz et al., 2021 ). Indeed, the term “metabolic memory” coins the pathogenic alterations induced by hyperglycemia long after accomplishment of glycemic control ( Genuth et al., 2002 ; Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group, 2003 ).…”

Urinary and Plasma Antioxidants in Behavioral Symptoms of Individuals With Autism Spectrum Disorder

“…Of reference, a lot of previous clinical studies indicated large age ranges in patients and healthy controls. Several clinical studies, for example, showed that 34.68 ± 15.43 years old in 65 patients with diabetes mellitus and 47.33 ± 19.58 years old in 27 healthy controls (94), and that 70.5 ± 2.1 years old in 50 heart failure patients in New York, and 47.9 ± 9.7 years old in 28 healthy university population (95); (d) given the small sample sizes, this study employed two types of measures: first, an endogenous antioxidant system is needed for comparing larger sample size and better-controlled studies described in the Journal of American Medical Association (JAMA) (96). Of reference, the present findings were supported by previous studies (10, 12-15, 97, 98).…”

Dynamic circadian fluctuations of glycemia in patients with type 2 diabetes mellitus

“…We recently developed a predictive model to determine maximum and minimum glycemic oscillations and the hour of the day at maximum and minimum glycemic oscillations in patients with T1D [15]; given that patients with T2D display different oscillatory days, we used the same model to test whether it could apply to T2D. Our data indicated that it was possible to predict hyperglycemia (p < 0.001) and hypoglycemia (p < 0.001) in patients with T2D (Fig.…”

“…Type 2 DM is characterized by hyperglycemia, increased HbA1c, and overweight [12,13]. Importantly, it has been proposed that the early detection of dysglycemic episodes (acute and chronic glucose excursions) might help improve outcomes in patients with DM [14,15]. Nevertheless, while T2D can be treated with diet, exercise, and medication, there is no accurate classification of glycemic oscillations in patients with T2D.…”

“…Continuous glucose monitoring (CGM) provides realtime glucose measurements, allowing for the reliable determination of hypoglycemia/hyperglycemia episodes and, consequently, glycemic variability over several days, weeks, or even months [19,20]. We recently characterized and classified glycemic oscillations in patients with T1D through CGM [15], finding that glycemic variability has different oscillatory patterns that are not entirely stochastic and exhibit circadian rhythmicity [21,22]. As far as we know, there is no accurate classification of glycemic oscillations in T2D.…”