Assessing the temporal within-day glycemic variability during hospitalization in patients with type 2 diabetes patients using continuous glucose monitoring: a retrospective observational study

• Published in: Diabetology and metabolic syndrome 2024-03, Vol.16 (1), p.56-56, Article 56
• Main Authors: Xing, Ying, Wu, Min, Liu, Hongping, Li, Penghui, Pang, Guoming, Zhao, Hui, Wen, Tiancai
• Format: Article
• Language: English
• Subjects: Antidiabetics; Blood glucose; Blood levels; Blood sugar; Blood sugar monitoring; Body mass index; Care and treatment; China; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetics; Diagnosis; GLP-1 receptor agonists; Glucagon; Glucagon-like peptide 1; Glucose monitoring; Glycemic fluctuations; Glycemic stability; Health aspects; Hospital patients; Hospitalization; Hospitals; Hyperglycemia; Hypoglycemia; Medical records; Mortality; Observational studies; Overweight; Oxidative stress; Patients; Peptides; Regression analysis; Type 2 diabetes; Variables; Within-day glycemic variability; α-Glucosidase
• ISSN: 1758-5996; 1758-5996
• DOI: 10.1186/s13098-024-01269-0

Frequent and extensive within-day glycemic variability (GV) in blood glucose levels may increase the risk of hypoglycemia and long-term mortality in hospitalized patients with diabetes. We aimed to assess the amplitude and frequency of within-day GV in inpatients with type 2 diabetes and to explore the factors influencing within-day GV. We conducted a single-center, retrospective observational study by analyzing hospital records and 10-day real-time continuous glucose monitoring data. Within-day GV was assessed using the coefficient of variation (%CV). The primary outcome was the amplitude and frequency of within-day GV. The frequency of within-day GV was assessed by the consecutive days (CD) of maintaining within the target %CV range after first reaching it (CD after first reaching the target) and the maximum consecutive days of maintaining within the target %CV range (Max-CD). The target %CV range was less than 24.4%. We evaluated the factors influencing within-day GV using COX regression and Poisson regression models. A total of 1050 cases were analyzed, of whom 86.57% reduced the amplitude of within-day GV before the sixth day of hospitalization. Of the 1050 hospitalized patients, 66.57% stayed within the target %CV range for less than two days after first reaching the target and 69.71% experienced a Max-CD of fewer than four days. Reducing the average postprandial glucose excursion (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.77-0.85; incidence rate ratios [IRR]: 0.72, 95% CI: 0.69-0.74) and the use of α-glucosidase inhibitors (IRR: 1.1, 95% CI: 1.01-1.18) and glucagon-like peptide-1 agonist (IRR: 1.30, 95% CI: 1.02-1.65) contributed to reducing the amplitude and decreasing the frequency of within-day GV. However, the use of insulin (HR: 0.64, 95% CI: 0.55-0.75; IRR: 0.86, 95% CI: 0.79-0.93) and glinide (HR: 0.47, 95% CI: 0.31-0.73; IRR: 0.84, 95% CI: 0.73-0.97) may lead to an increased frequency of within-day GV. An increasing frequency of within-day GV was observed during the hospitalization in patients with type 2 diabetes, despite the effective reduction in the amplitude of within-day GV. Using medications designed to lower postprandial blood glucose could contribute to minimize the risk of frequent within-day GV.