Blood Glucose Variability Research Articles

Analysis of the effect of liraglutide on glycemic variability in patients with type 2 diabetes.

The efficacy of liraglutide in the treatment of glycemic variability in type 2 diabetic patients remains to be fully elucidated. Some studies evaluated the efficacy and safety of liraglutide in glycemic variability, and this meta-analysis was performed to evaluate the accuracy of the results of existing studies on the efficacy of liraglutide. We conducted a comprehensive search for all relevant studies published in PubMed, EMBASE, Cochrane Library, and China Academic Journal Full-Text Database from the beginning of 2011 to October 31, 2019. The mean ± SD and 95% confidence interval were used for evaluation, and subgroup and sensitivity analysis were carried out. Publication bias was estimated by funnel plots and Egger's tests. A total of 16 studies were included in the meta-analysis involving 492 participants. MAGE (mean amplitude of glycemic excursion), LAGE (largest amplitude of glycemic excursions), SD (standard deviation of blood glucose), and MODD (mean of daily differences) were collected to reflect the variability of blood glucose. The glycemic variability indexes of patients before and after treatment with liraglutide were compared. Patients with treatment had lower glycemic variability compared with patients receiving treatment of liraglutide. Compared with the patients before the treatment, the patients after the treatment had a smaller glycemic variability (MAGE: I2 = 92%, p < 0.01, Z = 11.91, p < 0.01, MD = -2.78, 95%CI: -3.24 - -2.32; LAGE: I2 = 76%, p = 0.08, Z = 9.94, p < 0.01, MD = -2.20, 95%CI: -2.59 - -1.81; MODD: I2 = 74%, p = 0.002, Z = 14.03, p < 0.01, MD = -0.90, 95%CI: -1.02 - -0.77; SD: I2 = 93%, p < 0.01, Z = 3.62, p < 0.01, SMD = -1.77, 95%CI: -2.73 - -0.81). Sensitivity analysis showed that our results were reliable and no evidence of significant publication bias was detected. The results of this study suggest that patients with type 2 diabetes treated with liraglutide are associated with lower glycemic variability.

Glycaemic indices of commonly consumed Sri Lankan foods and variation in blood glucose

The paper presents data on glycaemic indices (GI), glycaemic load (GL) and some factors that contributed to the variations observed in GI of commonly consumed Sri Lankan foods. New improved raw (kekulu) rice if eaten with minimum of accompaniments gives rise to a higher GI in contrast to, consuming as a mixed meal with many curries which elicits a low GI. However, parboiled rice elicits a low GI and traditional rice elicits a low or medium GI even with minimum of accompaniments. Bread gives rise to a lower GI (medium) if accompanied by curries. String hoppers irrespective of flour variety elicit a high GI even when given with many accompaniments. Pittu produces higher GI with wheat or rice flour but elicits lower GI when produced with kurakkan flour. In contrast roti elicits low or medium GI and boiled legumes low GI. Wet processed foods tend to elicit higher GI than dry processed foods. This data will be of use when recommending foods to individuals who need to control their energy and carbohydrate intake.

Health Care Provider Knowledge and Perceptions of FDA-Approved and Do-It-Yourself Automated Insulin Delivery.

Automated insulin delivery (AID) technology may reduce variability in blood glucose, resulting in lower risk for hypoglycemia and associated complications, and by extension improve quality of life. While clinical trials, research, and patient experience have consistently demonstrated the value of AID, this technology is still inaccessible to many patients. Patient-driven innovation has resulted in alternative do-it-yourself (DIY) solutions to available off-the-shelf AID devices. This two-phase cross-sectional observational study addressed health care provider (HCP) perceptions of AID as well as the perceived need for, development of, and evaluation of an AID fact sheet comparing the most commonly used Federal Drug Administration approved AID and DIY AID devices. Negative attitudes toward the use of DIY AID were low. The majority of HCPs saw their lack of knowledge about how DIY AID work to be the greatest barrier to answering patient questions about what is available (74.4%). Additionally, the majority of HCPs (64.5%) indicated they were either "likely" or "very likely" to use the fact sheet when answering patient questions about AID options. Increased awareness and utilization of AID technology offer hope to further reduce the burden of diabetes, but there is a need to bridge the knowledge gap about DIY AID. A fact sheet provides a way to facilitate discussions of this emerging technology between HCPs and patients. Next steps could investigate additional ways to put needed information in the hands of HCPs.

Relationship between fasting blood glucose and body mass index among students of a medical college

Background: Obesity is one of the most important modifiable risk factors in the pathogenesis of lifestyle diseases like atherosclerosis, hypertension and type 2 diabetes mellitus. Overweight or obese adolescents are at an increased risk of developing diabetes and hypertension in future. A study was done to determine the relationship between body mass index and fasting blood glucose among students of a tertiary care teaching hospital.&#x0D; Materials and methods: A cross sectional analytical study was carried out among all medical students in a tertiary care teaching hospital in Kerala who consented to participate after obtaining approval from Institutional Research and Ethics Committee. The study tools used were standardized weighing machine, stadiometer, Accu-check glucometer and strips, disposable needles and pre-designed questionnaire.&#x0D; Results: Among the 254 study participants, 67% were females. The prevalence of impaired fasting glucose is 18.11% in the study population. No significant correlation was found between fasting blood glucose and body mass index. There was an increase in median FBS as the BMI increases, though not statistically significant (p=0.08). In the linear regression model, the statistic R2 explains that 7.9% of the variability in fasting blood glucose is explained by body mass index.&#x0D; Conclusion: The prevalence of prediabetes among the study participants was very high and it was higher among those who were overweight. The need of the hour is to identify the high-risk group in the community right from the young age and initiate trials or intervention studies to prevent or delay the onset of diabetes.

Rapid-Acting Insulin Analogues Versus Regular Human Insulin: A Meta-Analysis of Effects on Glycemic Control in Patients with Diabetes

IntroductionThe aim of this meta-analysis was to investigate the impact of rapid-acting insulin analogues (RAIAs) and regular human insulin (RHI) on glycemic control, including long- and short-term glycemic variability as measured by glycated haemoglobin (HbA1c) and pre- and postprandial glucose (PPG).MethodsPubMed was searched for studies published between 1999 and 29 June 2016. Randomised controlled trials of patients with diabetes that assessed the effects of RAIAs or RHI on glycemic control, focusing on preprandial glucose, PPG and HbA1c, were included. Only studies that reported both means and standard deviations for those outcomes were analysed; from these data, weighted mean differences and 95% confidence intervals were generated to yield overall point estimates. The primary outcomes of the meta-analysis were the mean differences between RAIAs and RHI at the end of the study in PPG, preprandial glucose, and HbA1c.ResultsTwenty-seven studies (n = 7452) were included. The difference in PPG between RAIA- and RHI-treated patients was significant—in favour of RAIAs—in patients with type 1 diabetes (T1D) [− 22.2 mg/dL; 95% confidence interval (CI) − 27.4, − 17.0 mg/dL; P < 0.0001] but not in those with type 2 diabetes (T2D). For preprandial glucose, there was a non-significant trend favouring RHIs in T1D; no data were available for patients with T2D. In patients with T1D, the between-group difference in end-of-treatment (EOT) HbA1c favoured RAIAs (− 0.13%; 95% CI − 0.18, − 0.08%; P < 0.0001), but was not significant in patients with T2D. The main study limitations were the small number and heterogeneity of the included studies.ConclusionsThese results demonstrate that RAIAs are more effective at reducing PPG and improving HbA1c than RHIs in T1D. More data are required to assess the effect of these agents on glucose control in T2D.Plain Language SummaryIn patients with diabetes, the risk of complications is increased by poor control of blood glucose levels and high blood glucose variability. Complications may include cardiovascular disease, eye problems and amputation. Control and variability of blood glucose levels can be evaluated using a range of measures, including (i) glycated haemoglobin (HbA1c) level at the end of the treatment period; (ii) change in HbA1c level during the treatment period; (iii) fasting plasma glucose level; (iv) postprandial glucose (PPG) level; (v) change in blood glucose level after a meal. PPG levels following a meal are an important measure of overall metabolic control in diabetes, and reduction of glycemic variability (GV) can be achieved via reductions in PPG. Both rapid-acting insulin analogues (RAIAs; aspart, glulisine and lispro) and regular human insulin (RHI) are widely used in the management of diabetes. Using data from 27 randomised controlled trials involving more than 7000 patients, we investigated the impact of RAIAs and RHI on measures of glycemic control and variability in patients with type 1 diabetes (T1D) or type 2 diabetes (T2D). Our results show that, in patients with T1D, RAIAs are more effective than RHI at reducing PPG excursions and HbA1c. This indicates that glycemic control is better with RAIAs than with RHI. More data are required to assess the effects of RAIAs and RHI on glycemic control and variability in patients with T2D.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-019-00732-w) contains supplementary material, which is available to authorized users.

Relationship between long-term blood glucose variability and major adverse cardiovascular events in patients with acute coronary syndrome

Objective To investigate the relationship between blood glucose variability and major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) . Methods From July to Decebmer 2017, The fasting blood glucose (FBG) of 125 ACS patients was dynamically monitoredfor 1 year after discharge. The coefficient of variance (CV) of blood glucose was calculated and the morbidity of MACE was recorded. Logistic regression analysis was used to analyze the relationship between the CV of blood glucose and MACE. The receiver operating characteristic (ROC) curves were used to evaluate the predictive power of the CV of blood glucose for MACE. Results The morbidity of MACE was 15.2%, which was positively correlated with the CV of blood glucose (OR=1.461; 95%CI: 1.202-1.775; P<0.001) and negatively correlated with high density lipoprotein (HDL) levels (OR=0.008; 95%CI: 0.000-0.684; P=0.033) .The CVof blood glucose showed a predictive power for the morbidity of MACE, whose cutoff value was 18.4%. Conclusions Long-term variability is a risk factor for the morbidity of MACE after discharge in ACS patients. Continuous care should be strengthened for patients after discharge, controlling their blood glucose while reducing the volatility of blood glucose. Key words: Blood glucose variability; Coefficient of variance (CV); Acute coronary syndrome (ACS); Major adverse cardiovascular events (MACE)

Meal timing, meal frequency, and breakfast skipping in adult individuals with type 1 diabetes \u2013 associations with glycaemic control

We assessed meal timing, meal frequency, and breakfast consumption habits of adult individuals with type 1 diabetes (n = 1007) taking part in the Finnish Diabetic Nephropathy Study, and studied whether they are associated with glycaemic control. Data on dietary intake and blood glucose measurements were retrieved from food records. HbA1c was measured at the study visit. In the whole sample, four peaks of energy intake emerged. Energy intake was the greatest in the evening, followed by midday. Altogether 7% of the participants reported no energy intake between 05:00 and 09:59 (breakfast skippers). While breakfast skippers reported lower number of meals, no difference was observed in the total energy intake between those eating and omitting breakfast. In a multivariable model, skipping breakfast was associated with higher mean blood glucose concentrations and lower odds of good glycaemic control. A median of 6 daily meals was reported. Adjusted for confounders, the number of meals was negatively associated with HbA1c, and the mean of the blood glucose measurements, but positively associated with the variability of these measurements. Our observations support the habit of a regular meal pattern, including consumption of breakfast and multiple smaller meals for good glycaemic control in adults with type 1 diabetes. However, an increase in the blood glucose variability may additionally be expected with an increase in the number of meals eaten.

Effect of Insulin and Fasting Regimen on Blood Glucose Concentrations of Diabetic Dogs During Phacoemulsification.

This study aimed to compare four protocols for preanesthetic insulin administration and fasting time with respect to the variation of intraoperative blood glucose (BG) concentrations versus preanesthetic values (baseline). The patient records of dogs undergoing cataract surgery were included. Data on anesthetic protocols, comorbidities, and intraoperative complications (hyper- and hypoglycemia, hypotension, hypothermia, and bradycardia) were analyzed. The insulin/fasting protocols included (A) 12 hr fasting and half insulin dose, (B) 6 hr fasting and half insulin dose, (C) 12 hr fasting and full insulin dose, and (D) 12 hr fasting and no insulin. Forty-eight dogs were included (14 in A, 10 in B, 13 in C, and 11 in D). Protocol D resulted in a significant increase of intraoperative BG concentrations compared with baseline (P = .001), whereas in the remaining groups, the baseline BG did not differ from intraoperative values. There were no statistically significant associations between the treatment group and the occurrence of intraoperative complications or the presence of diagnosed comorbidities. In conclusion, different insulin and fasting regimen protocols may be used for diabetic patients with no apparent benefit or risk from one protocol versus another. The use of insulin before surgery results in lesser increase of BG intraoperatively as compared with preanesthetic values. However, whether this should be interpreted as better perioperative control of glycemia remains debatable.

Development and application of continuous and noninvasive glucose monitoring technology

Blood glucose monitoring is an important part and means in the process of diabetes treatment and management. There is a high correlation between glucose concentration in interstitial fluid and glucose concentration in blood. Real-time monitoring of glucose concentration in interstitial fluid has important clinical significance. Continuous glucose monitoring (CGM) is an emerging glucose monitoring technology, which indirectly reflects the blood glucose level of the body through the glucose level in the interstitial fluid, providing continuous and comprehensive information and rules of blood glucose variation over a period of time. There are three main categories of CGM: minimally invasive implantation, non-invasive microtransparency and non-invasive technology. Noninvasive blood glucose monitoring technology is the future development direction, but accuracy and delay of blood glucose will be the biggest challenge to be overcome in clinical application. Key words: Blood glucose monitoring; Continuous glucose monitoring; Noninvasive glucose monitoring

Relationship between glucose control, glycemic variability, and oxidative stress in children with type 1 diabetes

IntroductionFew studies assessing the relationship between oxidative stress and glycemic variability in children with type 1 diabetes mellitus (T1DM) are available, and most of them reported no significant results. ObjectiveTo assess the relationship between glucose control, glycemic variability, and oxidative stress as measured by urinary excretion of 8-iso-prostanglandin F2-alpha (8-iso-PGF2α) in children with T1DM. Materials and methodsA cross-sectional study including 25 children with T1DM. Participants were evaluated during five days in two different situations: 1st phase during a summer camp, and 2nd phase in their everyday life at home. The following data were collected in each study phase:.– Six capillary blood glucose measurements per day. Mean blood glucose (MBG) levels and glucose variability parameters, including standard deviation, coefficient of variation, and mean amplitude of glycemic excursions (MAGE), were calculated.– Capillary HbA1c level.– 24-h urine sample to measure 8-iso-PGF2α. ResultsThere were no statistically significant differences in urinary 8-iso-PGF2α levels (142±37 vs. 172±61pg/mg creatinine) and glucose control and glycemic variability parameters between both phases. In the 2nd phase, statistically significant correlations were found between urinary 8-iso-PGF2α and HbA1c levels (r=0.53), MBG (r=0.72), standard deviation (r=0.49), and MAGE (r=0.42). No significant correlations between glucose control, glycemic variability and urinary 8-iso-PGF2α excretion were found in the 1st phase. ConclusionsA significant correlation was found between glycemic variability and HbA1c level and urinary 8-iso-PGF2α excretion in a group of children with T1DM during their daily lives. Additional studies are needed to confirm this finding and to explore its long-term impact on health.

Impact of Carbohydrate on Glucose Variability in Patients with Type 1 Diabetes Assessed Through Professional Continuous Glucose Monitoring: A Retrospective Study

IntroductionThe aim of this study was to objectively analyze the correlation between dietary components and blood glucose variation by means of continuous glucose monitoring (CGM).MethodsPatients with type 1 diabetes mellitus (T1DM) who received CGM to manage their blood glucose levels were enrolled into the study, and the components of their total caloric intake were analyzed. Glycemic variation parameters were calculated, and dietary components, including percentages of carbohydrate, protein and fat in the total dietary intake, were analyzed by a dietitian. The interaction between parameters of glycemic variability and dietary components was analyzed.ResultsSixty-one patients with T1DM (33 females, 28 males) were enrolled. The mean age of the participants was 34.7 years, and the average duration of diabetes was 14 years. Glycated hemoglobin before CGM was 8.54%. Participants with a carbohydrate intake that accounted for < 50% of their total caloric intake had a longer DM duration and a higher protein and fat intake than did those with a carbohydrate intake that accounted for ≥ 50% of total caloric intake, but there was no between-group difference in total caloric intake per day. The group with a carbohydrate intake that accounted for < 50% of their total caloric intake also had lower nocturnal continuous overlapping net glycemic action (CONGA) 1, − 2 and − 4 values. The percentage of protein intake had a slightly negative correlation with mean amplitude of glycemic excursions (MAGE) (r = − 0.286, p < 0.05) and a moderately negative correlation with coefficient of variation (CV) (r = 0.289, p < 0.05). One additional percentage of protein calories of total calories per day decreased the MAGE to 4.25 mg/dL and CV to 0.012 (p < 0.05). The optimal dietary protein percentage for MAGE < 140 mg/dL was 15.13%. The performance of predictive models revealed the beneficial effect of adequate carbohydrate intake on glucose variation when combined with protein consumption.ConclusionsAdequate carbohydrate consumption—but not more than half the daily total calories—combined with protein calories that amount to approximately 15% of the daily caloric intake is important for glucose stability and beneficial for patients with T1DM.Electronic supplementary materialThe online version of this article (10.1007/s13300-019-00707-x) contains supplementary material, which is available to authorized users.

Dietary carbohydrate intake and cardio-metabolic risk factors in type 1 diabetes

AimsLow-carbohydrate diet (LCD) has gained interest among individuals with diabetes as a means to manage glycaemia. We investigated the adherence to LCD in the Finnish Diabetic Nephropathy Study and whether carbohydrate restriction is associated with cardio-metabolic risk factors. MethodsCross-sectional data were available from 902 individuals with type 1 diabetes (44% men, age 47 ± 13 years). Dietary data were collected twice with a 3-day diet record. Mean of the measurements was used. Carbohydrate intake <130 g/day or <26 E% was used as indication of LCD. Individuals reporting LCD were compared to sex-, diabetes duration- and eGFR-matched controls with higher carbohydrate intakes (>253 g/day or >48 E%). In the whole population, carbohydrate-to-fat ratio was calculated and its association with health variables was investigated. ResultsHigher carbohydrate-to-fat ratio was associated with higher blood glucose variability, higher blood pressure, lower HDL cholesterol concentration, and in men with lower waist-to-hip ratio. LCD adherence (n = 69) was associated with lower BMI (25.6 vs. 27.8 kg/m2, p = 0.030), lower variability of blood glucose measurements (0.38 vs. 0.45 mmol/l, p = 0.030), and lower diastolic blood pressure (74 vs. 79 mmHg, p = 0.048). Men reporting LCD had higher total (5.1 vs. 4.0 mmol/l, p = 0.007) and non-HDL cholesterol (3.4 vs. 2.7 mmol/l, p = 0.021). Women with LCD had higher HDL-cholesterol concentration (1.9 vs. 1.5 mmol/l, p = 0.014). ConclusionsReduced blood glucose variability, related to LCD, could have clinical relevance to individuals with type 1 diabetes.

Independent Association of Glucose Variability With Hospital Mortality in Adult Intensive Care Patients: Results From the Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Binational Registry.

Retrospective, registry data analyses of outcomes. Large, binational registry (Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database repository) of 176 ICUs across Australia and New Zealand. We used 10-year data on nonhyperglycemic patients registered in the Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database repository (n = 290,966). None. Glucose variability was captured using glucose width defined as the difference between highest and lowest blood glucose concentration within first 24 hours of ICU admission. We used hierarchical, mixed effects logistic regression models that accounted for ICU variation and several fixed-effects covariates. Glucose width was specifically and independently associated with hospital mortality. The association of blood glucose variability with mortality remained significant (odds ratio for highest vs lowest quartile of glucose, 1.43; 95% CI, 1.32-1.55; p < 0.001) even after adjusting for the baseline risk of mortality, midpoint blood glucose level, occurrence of hypoglycemia and inter-ICU variation. Mixed effects modeling showed that there was a statistically significant variation in this association across ICUs. Our study demonstrates that glucose variability is independently associated with hospital mortality in critically ill adult patients. Inclusion of correction for glucose variability in glycemic control protocols needs to be investigated in future studies.

Monthly Video-Consultation for Children With Type 1 Diabetes Using a Continuous Glucose Monitoring System: Design of ViDiKi, a Multimethod Intervention Study to Evaluate the Benefit of Telemedicine.

The introduction of continuous glucose monitoring (CGM) implies new challenges for diabetes care. As CGM systems are often directly linked to a web-based software solution, structured telemedicine care using a video-consultation may be a new option for families who care for children with type 1 diabetes mellitus (T1DM). "ViDiKi" (Virtual Diabetes Outpatient Clinic for Children and Youth) is a multicenter controlled trial carried out in Northern Germany. ViDiKi will examine if monthly telemedical consultations, in addition to regular care, will improve glycemic control and psychosocial outcomes. The primary outcome is glycemic control as measured by a change in glycated hemoglobin (HbA1c). A total of 240 participants aged between one year and 16 years using a CGM with multiple daily injections (MDI) or insulin pump therapy were recruited and assigned to a starter group or a six-month waiting control group. The sample size is designed to detect a between-group difference of 0.5% in HbA1c change at six months. Secondary outcomes are variability of blood glucose, health-related quality of life, self-efficacy, and satisfaction with telemedicine. To gain deeper insight into the experience of using telemedicine, qualitative interviews will be conducted. In a health-economic analysis, the costs of telemedicine and a cost-of-care analysis will be calculated. The results from the ViDiKi study shall give important information on the feasibility and putative benefits of telemedicine in children with T1DM and their caregivers. DRKS00012645.

Usefulness of Glycemic Control Using an Artificial Pancreas Apparatus for Cardiovascular Surgery

Blood glucose management is important for cardiovascular surgery using cardiopulmonary bypass. The usefulness of an artificial pancreas apparatus (STG-55) to control blood glucose in patients undergoing cardiopulmonary bypass was investigated. Subjects comprised 44 patients using the artificial pancreas during cardiopulmonary bypass between June 2016 and March 2017; 55 were initially enrolled, but 11 were excluded because of blood removal failure. Patients were divided into a monitoring group in which blood glucose levels were only monitored using the artificial pancreas (11 patients: six people with diabetes and 5 people without diabetes) and a management group with glycemic control by automatic insulin administration using the artificial pancreas (33 patients: people with diabetes and 21 people without diabetes). Mean maximum blood glucose levels and variation ranges significantly differed between the monitoring and management groups (p = 0.02). The variation range significantly differed between people with and without diabetes in the monitoring group (p = 0.008), but not in the management group. The artificial pancreas apparatus continuously and accurately reflected glycemic variations, facilitating strict and favorable control.

Hydrocortisone Continuous Infusion Versus Bolus Dose on Glycemic Control in Critically Ill Subjects

Background: Corticosteroid therapy in patients with septic shock can improve hemodynamics but can also cause hyperglycemia. Continuous infusion (CI) hydrocortisone has limited evidence that it may reduce hyperglycemia relative to bolus dose (BD) therapy, but CI can be cumbersome and requires attention to intravenous access and drug incompatibilities. Objective: To compare the effects of CI hydrocortisone with BD on glycemic control. Methods: A matched, retrospective cohort study of blood glucose, insulin requirements, and glycemic variability was performed between patients with shock receiving CI and BD hydrocortisone. Patients were matched based on history of type 2 diabetes and intensive care unit (ICU) admission. Results: Baseline blood glucose was similar between groups, with higher baseline hourly insulin requirements in the CI group (CI: 12 [12.8] units, BD: 6.7 [7] units, P = .0012). For the first 72 hours of treatment, there was no difference in mean blood glucose with higher average hourly insulin requirements in the CI group (CI 7.8 [7.7] units, BD: 5.5 [6.9] units, P < .0001). There was no difference in glycemic variability between groups. Conclusions: CI hydrocortisone therapy for septic shock does not appear to have a favorable impact on mean blood glucose or influence glycemic variability relative to BD therapy.

74-LB: Impact of Mild and Moderate High Blood Glucose Excursions on Daily Living in Adults with Type 1 Diabetes

Introduction: Severe hyperglycemic events and diabetic ketoacidosis (DKA) have significant effects on daily activity however, the effect of mild and moderate glucose excursions on functioning and quality of life (QoL) remains unknown. This study aimed to assess the impact of these excursions on well-being in a well-managed population with type 1 diabetes (T1D) using survey and CGM data. Methods: Adults with T1D (N = 71), 68.6% female, 93.2% white, aged 44.11 years, average A1c 6.51%, with diabetes for 26.65 years, completed an online survey through T1D Exchange Glu and uploaded CGM data via Tidepool. Results: Moderate high blood glucose (HBG) excursions were most strongly related to QoL (WHO-5) and happiness (Subjective Happiness Scale, SHS). Participants with fewer mild (&amp;gt; 180 mg/dL) HBG excursions had higher WHO-5 scores indicating better QoL when controlling for income and duration of diabetes. Participants who had longer durations in the same range, regardless if it was time in range or mild or moderate hyperglycemia, had higher SHS scores indicating greater happiness when controlled for income and duration of diabetes. Conclusions: This study illustrates the impact of mild HBG excursions and glycemic variability on QoL in people with T1D. HBG excursions were related to QoL and glycemic variability was related to happiness further supporting the urgency to decrease the amount of time hyperglycemic. These results indicate the need to increase time in range and decrease overall blood glucose variability. A limitation includes convenience sampling in a very well-managed population. Future research should further investigate the relationships of these factors in a diverse sample. Disclosure A. Hughes: None. J. Bispham: None. C. Garey: None. J. Liu: None. L. Fuller: None. E.T. Nykaza: None. J.A. Meno: None. A. McAuliffe-Fogarty: None.

2429-PUB: Circulating microRNAs Are Associated with Glycemic Variability over a 12-Month Period

Introduction: Circulating microRNAs (miRs) function as mediators of biological responses to the environment and may provide insights into mechanisms for type 2 diabetes (T2D). A limitation of prior studies is their cross-sectional design. We sought to characterize variability in fasting blood glucose (FBG) at 5 time-points over a 12-month period in order to determine whether FBG variability was associated with circulating miR expression and identify miR-associated biological pathways. Methods: Participants were from a previously completed trial on restorative yoga for overweight/obese adults with prediabetes. FBG variability was defined using the standard deviation across 5 time-points. A subset of participants with high (n=10) vs. low (n=10) FBG variability, matched by age and sex, were evaluated. Expression of 336 miRs collected at baseline was measured with the Fireplex Circulating MicroRNA assay. False discovery rate (FDR) threshold of 0.2 was applied. The miRPathDB database was used to identify KEGG pathways. Results: A total of 6 miRs (i.e., miR-192, miR-197, miR-206, miR-424, miR-486, miR-93) were differentially expressed between individuals with highly compared to low FBG variability. For the six miRs identified in both batches, 321 KEGG pathways were targeted. The Insulin signaling pathway was targeted by miR-197, miR-206, miR-424, and miR-486; the Insulin secretion pathway was targeted by miR-486; and the type 2 diabetes mellitus pathway was targeted by miR-197, miR-206, miR-424, and miR-486. Conclusions: Circulating miRs are associated with variability in FBG and miRs target pathways that are known to underlie risk for T2D. The immediate next step is to perform longitudinal analysis of the relationships between FBG and circulating miRs to explore novel pathway targets to derive new insights about mechanisms for T2D. Disclosure E. Flowers: None. I.D. Allen: None. A.M. Kanaya: None. B. Aouizerat: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R21DK117346-01A1)

947-P: Glucose Variability: Insulin Pump vs. Multiple Daily Injection in Type 1 Diabetes Evaluated by Continuous Glucose Monitoring

Background: This study compared the effects of insulin pump (IP) vs. multiple daily injection therapy (MDI) on glucose variability (GV) evaluated by professional Continuous Glucose Monitoring (CGM) in real-life condition of patients with type 1 diabetes (T1D). Methods: This was a parallel study in 120 T1D patients, with a mean age of 31.2 years, and hemoglobin A1c (HbA1c) level of 8.3%; 99 patients were treated MDI (66 patients with Glargine U100, 13 with Detemir, 20 with Degludec U100) and 21 with IP. The primary end point was the coefficient of variation (CV) of blood glucose. Secondary end points included HbA1c, mean amplitude of glycemic excursions (MAGE). We compared IP vs. MDI. Results: IP was not different to MDI respect to CV (37.94±1.68 vs. 40.32±075; p=0.12) and HbA1c (8.59±0.20 vs. 8.23±0.15; p=0.39). There were also no significant differences between treatment groups with respect to MAGE (308.75±11.28 vs. 309.22±5.17; p=0.92) and total doses of insulin (35.14±4.77 vs. 42.88±2,22; p=0.36). In multiple regression analyses, the CV was positively associated with MAGE and negatively with HbA1c only 22% (R2: 0,22, p = 0.01). Conclusion: In our population in real world data, no significant difference was observed in the GV indicators in patients treated with MDI vs. IP. Disclosure A.E. Proietti: None. A.V. Daghero: None. M.L. Scapuzzi: None. M.L. Iglesias: None. J.P. Nogueira: None.

Effects of Variability in Blood Pressure, Glucose, and Cholesterol Concentrations, and Body Mass Index on End-Stage Renal Disease in the General Population of Korea.

Aim: Metabolic parameters, such as blood pressure, glucose, lipid levels, and body weight, can interact with each other, and this clustering of metabolic risk factors is related to the progression to end-stage renal disease (ESRD). The effect of variability in metabolic parameters on the risk of ESRD has not been studied previously. Methods: Using nationally representative data from the Korean National Health Insurance System, 8,199,135 participants who had undergone three or more health examinations between 2005 and 2012 were included in this analysis. Intraindividual variability in systolic blood pressure (SBP), fasting blood glucose (FBG), total cholesterol (TC), and body mass index (BMI) was assessed by examining the coefficient of variation, variability independent of the mean, and average real variability. High variability was defined as the highest quartile of variability and low variability was defined as the lower three quartiles of variability. Results: Over a median (5–95%) of 7.1 (6.5–7.5) years of follow-up after the variability assessment period, 13,600 (1.7/1000 person-years) participants developed ESRD. For each metabolic parameter, an incrementally higher risk of ESRD was observed for higher variability quartiles compared with the lowest quartile. The risk of ESRD was 46% higher in the highest quartile of SBP variability, 47% higher in the highest quartile of FBG variability, 56% higher in the highest quartile of BMI variability, and 108% higher in the highest quartile of TC variability. Compared with the group with low variability for all four parameters, the group with high variability for all four parameters had a significantly higher risk for incident ESRD (hazard ratio (HR) 4.12; 95% CI 3.72–4.57). Conclusions: Variability in each metabolic parameter was an independent predictor of the development of ESRD among the general population. There was a composite effect of the variability in additional metabolic parameters on the risk of ESRD.