Abstract
Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4–10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (–0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [–2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.
Highlights
Recent evidence has demonstrated that insulin has an anti-oxidative and anti-inflammatory action in humans [1]
One underlying reason for this discrepancy is that HbA1c cannot reflect glycemic variability (GV), which is mainly due to progressive insulin deficiency, which increases with duration of type 2 diabetes
This study demonstrated that in poorly controlled type 2 diabetes mellitus (T2DM) on a background regimen of metformin and multiple daily injections of insulin (MDI) therapy, both continuous subcutaneous insulin infusion (CSII) and liraglutide therapy showed increased efficacy in glycemic control, and the addition of liraglutide to CSII therapy conferred greater benefits than CSII alone
Summary
Recent evidence has demonstrated that insulin has an anti-oxidative and anti-inflammatory action in humans [1]. Intensive insulin therapy has been shown to reduce the risk of microvascular complications in the short-term and macrovascular complications after 10 years of post-trial follow-up in newly diagnosed patients with type 2 diabetes [2,3,4]. Short-term intensive insulin treatment could effectively optimize the sugar control profile and improve b-cell function [5]. CGMSs can record real-time glycemic values and trends by providing a large number of blood glucose recordings [7]. They have not been widely used because of device limitations such as short sensor lifetimes and the need for SMBG for device calibration. One underlying reason for this discrepancy is that HbA1c cannot reflect glycemic variability (GV), which is mainly due to progressive insulin deficiency, which increases with duration of type 2 diabetes
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