Abstract
To observe whether different insulin glargine titration algorithms based on fasting blood glucose (FBG) levels lead to different glycaemic variations (GVs) in type 2 diabetes (T2D) patients, a prospective, randomized, single-centre, comparative, three-arm parallel-group, open-label, treat-to-target, 24-week study was performed. A total of 71 uncontrolled T2D patients were recruited and randomized 1 : 3 : 3 into Groups 1, 2, and 3 (insulin titration goals of FBG ≤ 5.6, ≤6.1, and ≤7.0) for this study. The initiated insulin glargine dose was recommended at 0.2 U/kg/day and was then titrated following the FBG target. Patients were subjected to two 3-day continuous glucose monitoring (CGM) at baseline and the endpoint, wherein the CGM data were analysed, and the study's primary endpoint was the difference in 24 hrs mean amplitude of glycaemic excursion (MAGE) among the three groups. We observed that patients in the three groups had similar MAGE levels at the endpoint; however, Group 2 achieved a significant decrease in the MAGE level from baseline to the endpoint as compared to Groups 1 and 3 (all p < 0.05). We also observed that these patients had significant glycated haemoglobin A1c (HbA1c) value improvements as compared to the other two groups (all p < 0.05). Therefore, choosing an FBG level of 6.1 mmol/L as an insulin titration target provided significant GVs and HbA1c value improvements in T2D patients. Moreover, our data indicated that an FBG of 6.1 mmol/L could possibly be an insulin glargine titration target in T2D patients.
Highlights
China is among the top 10 countries for the highest number of diabetes patients (114 million), as well as total healthcare expenditure on diabetes [1]
A study conducted in China reported that 67.5% of Chinese type 2 diabetes (T2D) patients were on insulin therapy, but only 15% of them had glycated haemoglobin A1c (HbA1c) levels of less than 7.0% [3]
A previous study demonstrated that a reduction in HbA1c value in diabetes patients was associated with a decrease in the risk of microvascular and macrovascular complications [7]
Summary
China is among the top 10 countries for the highest number of diabetes patients (114 million), as well as total healthcare expenditure on diabetes [1]. Microvascular and macrovascular complication incidences, in particular, depend largely on the glycaemic control of diabetic patients [2]. A study conducted in China reported that 67.5% of Chinese type 2 diabetes (T2D) patients were on insulin therapy, but only 15% of them had glycated haemoglobin A1c (HbA1c) levels of less than 7.0% [3]. A previous study demonstrated that a reduction in HbA1c value in diabetes patients was associated with a decrease in the risk of microvascular and macrovascular complications [7]. It should be noted that HbA1c does not necessarily refer to daily glucose variations (GVs), since studies have found that patients with different GVs may have similar HbA1c values [8,9,10]. The role of HbA1c and GVs should be highlighted in T2D to decrease diabetic
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