Factors Associated with High Glycemic Variability Defined by Coefficient of Variation in Hypo-Prone Type 2 Diabetes

Abstract

Objective: To determine clinical variables associated with high glucose variability (GV) evaluated by continuous glucose monitoring (CGM) in patients with type 2 diabetes (T2D) and high risk of hypoglycemia. Methods: A observational study with retrospective cohort analysis of the data was done. We included patients with T2D and history of hypoglycemia as an indication of CGM. GV was calculated using different metrics. They were classified depending on the coefficient of variation (CV) in 2 groups (<30% and ≥30%). Hypoglycemia was defined as interstitial glucose levels lower than 54 mg/dL for at least 20 minutes. For possible association between clinical variables and the CV, we did a bivariate dichotomous logistic regression model, then for the construction of the multivariate model, all the variables were included. Results: 148 patients were included, 52 patients had hypoglycemia (35.1%). 52.0% were classified in the group with CV ≥ 30%. Three variables presented statistically significant differences: BMI comparing overweight vs. normal (OR 0.35; IC 95%, 0.16-0.78, p 0.010) and obesity vs. normal BMI (OR 0.34; IC 95%, 0.14-0.82, p 0.017), duration of diabetes (OR 1.03; IC 95%, 1.00-1.07, p 0.047) and glomerular filtration rate (GFR) between 30-45 ml/min (OR 2.93; IC 95%, 1.06-8.06, p 0.037), in the bivariate analysis. Female gender (OR 2.14; IC 95%, 1.03-4.46, p 0.041), BMI comparing overweight vs. normal (OR 0.31; IC 95%, 0.13-0.73, p 0.007) and obesity vs. normal BMI (OR 0.22; IC 95%, 0.06-0.61, p 0.003), GFR between 30-45 ml/min (OR 3.92; IC 95%, 1.29-11.93, p 0.016) and diabetic neuropathy (OR 2.39; IC 95%, 1.07-5.32, p 0.033) presented statistically significant differences in the multivariate model. Conclusion: this study suggested association between clinical variables such as female gender, normal BMI, GFR between 30-45 and diabetic neuropathy with high CV in hypo-prone T2D patients. However, these results should be confirmed with randomized clinical trials. Disclosure A. Gomez: Research Support; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Eli Lilly and Company, Medtronic, Novartis Pharmaceuticals Corporation. Research Support; Self; Abbott.