Glucose Fluctuations In Type Research Articles

Effects of dulaglutide combined with insulin degludec on glucose fluctuations and appetite in type 2 diabetes.

The aim of this study was to describe appetite and glucose fluctuation in type 2 diabetes mellitus patients initiating treatment with dulaglutide combined with insulin degludec. This retrospective study of patients identified adults starting treatment with once-weekly (QW) dulaglutide combined with insulin degludec (experimental group) or insulin degludec alone (control group). Patients were followed for up to 6 months from treatment initiation. The clinical characteristics of patients, treatment patterns, CGM data, and appetite scores were obtained for the two groups. A total of 236 patients were included in this study. SDBG, MAGE, LAGE, and PPGE of the experimental group were lower than the control group's (P < 0.05). The proportions of patients achieving a time in range (TIR) of ≥70% in the experimental group were higher than in the control group, with 43% and 10% on the second day, 88% and 47% on the fourth day, 95% and 47% on the seventh day, and 100% and 67% on the tenth day, respectively. Significant associations existed between TIR and the prevalence of islet function. At six months, 89.2% of patients in the experimental group were still using dulaglutide. Appetite decreased significantly at 1 week and increased at 3 months after treatment with dulaglutide. Dulaglutide combined with insulin degludec significantly reduces glucose fluctuations in patients with type 2 diabetes mellitus and improves the TIR rate. However, the treatment on appetite could decrease in the first three months.

SGLT2 inhibitor ipragliflozin exerts antihyperglycemic effects via the blood glucose-dependent increase in urinary glucose excretion in type 2 diabetic mice

This study investigated the antihyperglycemic effects of the sodium-glucose cotransporter 2 (SGLT2) inhibitor ipragliflozin via the blood glucose-dependent increase in urinary glucose excretion in KK/Ay type 2 diabetic mice. In oral glucose tolerance tests (glucose load: 1, 2, or 4 g/kg) in 24-h-fasted mice, blood glucose levels increased in a glucose-loading dose-dependent manner. Oral administration of ipragliflozin (1 mg/kg) significantly inhibited the increase in blood glucose concomitant with urinary glucose excretion. To investigate the effects of ipragliflozin under low blood glucose conditions, blood glucose level and urinary glucose excretion were examined under fasting conditions in diabetic mice that had prefasted for 0, 6, 12, 18, or 24 h. Ipragliflozin significantly lowered blood glucose levels in mice that had prefasted for 0, 6, or 12 h, but not 18 h or more. Blood glucose level was well correlated with ipragliflozin-induced antihyperglycemic and urinary glucose excretion effects, suggesting that these effects occur in a blood glucose-dependent manner. Thus, in a hyperglycemic state, ipragliflozin exerts a potent antihyperglycemic effect and marked increases in urinary glucose excretion; however, in a non-hyperglycemic or hypoglycemic state, the hypoglycemic effect is weak. Ipragliflozin may therefore be a useful antidiabetic agent for normalizing daily blood glucose fluctuations in type 2 diabetes.

Increased serum level and impaired response to glucose fluctuation of asprosin is associated with type2 diabetes mellitus.

Aims/IntroductionAsprosin is a novel secreted adipokine that is induced by fasting and promotes hepatic glucose release. In healthy humans, circulating asprosin shows circadian oscillation with an acute drop coinciding with the onset of eating. The present study investigated whether this circadian oscillation still exists in patients with type 2 diabetes mellitus.Materials and MethodsWe recruited 60 patients with type 2 diabetes mellitus and 60 individuals with normal glucose tolerance (NGT). All participants completed a 75‐g oral glucose tolerance test. Fasting and 2‐h postprandial serum asprosin concentrations were measured by the enzyme‐linked immunosorbent assay method. Partial correlation coefficients were calculated to analyze the relationships between serum asprosin level and parameters of glucose metabolism. Multiple logistic regression analysis was used to determine the association of serum asprosin level with diabetes.ResultsBoth fasting and postprandial asprosin levels were significantly higher in patients with type 2 diabetes mellitus. The postprandial asprosin level was apparently lower than fasting asprosin level in individuals with NGT. The fasting asprosin level closely correlated with type 2 diabetes mellitus after multiple adjustment (odds ratio 2.329, P = 0.023). Asprosin correlated negatively with change in blood glucose (r = −0.502, P < 0.001) and change in C‐peptide (r = −0.467, P < 0.001) in individuals with NGT, but not in type 2 diabetes mellitus patients.ConclusionsSerum asprosin level decreased coinciding with the onset of the oral glucose tolerance test in individuals with NGT, whereas this circadian oscillation was disturbed in type 2 diabetes mellitus patients. The impaired response of asprosin to glucose fluctuation in type 2 diabetes mellitus patients might be one of the reasons for the onset of type 2 diabetes mellitus.

Analysis of the Effect of the Lowest SpO2 on Nocturnal Blood Glucose Fluctuation in Type 2 Diabetes Measured by WatchPAT and Continuous Glucose Monitoring

Although sleep apnea syndrome reportedly increases nocturnal blood glucose (BG) variability, few studies have assessed the effect of the lowest oxygen saturation (SpO2) during sleep on short-term BG levels. Thus, this prospective study of BG fluctuations while sleeping was conducted on subjects fitted with a continuous glucose monitoring (CGM) device and a WatchPAT®, allowing simple evaluation of sleep-disordered breathing. Ninety-two patients with type 2 diabetes were fitted with the two devices overnight in the hospital when the glycemia was stable (∼7-10 days) in order to avoid the effects of hyperglycemia. The subjects were aged at least 18 years. Results: The subjects were categorized according to their lowest SpO2 by WatchPAT (SpO2 ≥90%, 85%≤ and &amp;lt;90%, or &amp;lt;85%). As SpO2 decreased, elevated body mass index (BMI) (20.3±3.3 vs. 25.3±3.9 vs. 28.7±5.8 kg/m2, mean±standard deviation (SD); p&amp;lt;0.001) and increased endogenous insulin secretion (1.3±0.7 vs. 2.2±1.1 vs. 2.5±1.3 ng/mL; p=0.002) were observed. Using BG level at the time of the lowest SpO2 as baseline, comparison of the differences in BG values every 30 minutes for 3 hours showed significantly worsened BG levels for SpO2 &amp;lt;90% (30 min-baseline 4.4±3.2 vs. 180 min-baseline 18.7±22.4 mg/dL; p&amp;lt;0.001). In addition, in the 30 minutes after the lowest SpO2, the BG level was elevated in the SpO2 &amp;lt;85% group compared to those in the other groups (SpO2 ≤90% 4.1±3.2 vs. 85%≤ SpO2 &amp;lt;90% 4.4±3.2 vs. SpO2 &amp;lt;85% 7.8±6.9 mg/dL; p=0.03). In contrast, no significant differences were noted in mean BG, mean amplitude of glycemic excursions (MAGE), SD, or coefficient of variation (CV) among the three groups from 00:00 to 06:00. Conclusions: Even without differences in nocturnal fluctuations of BG levels, because of treatment, hypoxemia during sleep causes short-term worsening of glycemia. Moreover, the greater the degree of hypoxemia, the earlier the worsening is likely. Disclosure M. Shinoda: None. T. Yamakawa: None. R. Sakamoto: None. J. Suzuki: None. K. Takahashi: None. Y. Terauchi: Research Support; Self; MSD K.K.. Speaker's Bureau; Self; MSD K.K.. Advisory Panel; Self; MSD K.K.. Research Support; Self; Ono Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Mitsubishi Tanabe Pharma Corporation. Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Advisory Panel; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Speaker's Bureau; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi. Research Support; Self; Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Self; Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Shionogi &amp; Co., Ltd.. Speaker's Bureau; Self; Shionogi &amp; Co., Ltd., Bayer Yakuhin, Ltd., Astellas Pharma US, Inc., AstraZeneca. Advisory Panel; Self; AstraZeneca, Teijin Pharma Limited.

Heart rate variability is associated with interstitial glucose fluctuations in type 2 diabetic women treated with insulin.

Heart rate variability (HRV) analysis is a commonly used tool for assessment of autonomic function in diabetic subjects. Nevertheless, the effects of glucose fluctuations on HRV remain to be clarified. In this study we investigated the associations of frequency-domain HRV parameters with current and antecedent interstitial glucose fluctuations in insulin-treated type 2 diabetic women at high cardiovascular risk. Sixty-seven women with type 2 diabetes, from 48 to 78 years of age, including 46 ones with cardiovascular autonomic neuropathy (CAN), underwent simultaneous continuous glucose monitoring (CGM) and Holter recording. Eight glucose variability (GV) indices, including standard deviation, 2-h continuous overlapping net glycemic action (CONGA2), lability index, J-index, mean amplitude of glucose excursions, mean absolute glucose (MAG), low blood glucose index (LBGI) and high blood glucose index (HBGI), were calculated from CGM data. The low frequency (LF) and high frequency (HF) power values were estimated on 5-min intervals at fasting and postprandial daytime periods, at night and during CGM-defined hypoglycemia. The values of LF and HF power declined after meals in diabetic women with normal autonomic function tests. Patients with CAN demonstrated blunted postprandial LF and HF reduction and diminished LF/HF ratio during daytime hypoglycemic events. Daytime LF and HF at fasting state correlated negatively with MAG derived from antecedent nocturnal CGM recordings. Positive correlation was found between fasting LF and nocturnal LBGI. The LF power during daytime hypoglycemia demonstrated negative correlations with nocturnal CONGA2, J-index, HBGI and MAG. The nocturnal HBGI and CONGA2, along with HbA1c and daily insulin dose, were predictors of LF during daytime hypoglycemia in multiple regression analysis. Both postprandial and antecedent nocturnal glucose fluctuations affect daytime frequency-domain HRV parameters in insulin-treated type 2 diabetic women. In patients with increased GV the results of short-term assessment of HRV should be interpreted with caution. Fasting state rather than postprandial one seems to be preferable for HRV estimation.

GW24-e3985 Fluctuation of high glucose accelerates endothelial injury and oxidative stress via PI3k/Akt/GSK-3β pathway in type 2 diabetes mellitus rats

ObjectivesTo investigate the possible role of PI3k/Akt/GSK-3 signalling pathway in the pathogenesis of endothelial cells injury and oxidative stress induced by high glucose fluctuation in type 2 diabetes mellitus rats.Methods80...

Effect of the α-glucosidase inhibitor miglitol on the glucose profile in Japanese type 2 diabetic patients receiving multiple daily insulin injections

Strict postprandial glycemic control may have a preventive effect on atherogenesis in patients with type 2 diabetes. The α-glucosidase inhibitor (α-GI) miglitol is useful for controlling the early postprandial increase of glucose, but the combined effect of miglitol and multiple daily insulin injections (MDI) on glucose excursion has not been evaluated. First, we retrospectively compared the daily glucose profile, evaluated by self-monitoring of blood glucose (SMBG) at nine times on the day before discharge from hospital, between type 2 diabetic patients receiving MDI (n=81) or MDI plus miglitol at 150 mg daily (n=24). Second, we prospectively examined the effect of adding miglitol to MDI on the daily glucose profile (SMBG) in 19 other type 2 diabetic patients. Although the daily insulin dosage and the glucose level before meals did not differ between the two groups, the 1-h postprandial glucose level after each meal, 2-h glucose level after lunch and dinner, mean and standard deviation of glucose, and amplitude of glucose excursion were significantly lower or smaller in the MDI plus miglitol group than in the MDI group. All of these glucose parameters were significantly improved by adding miglitol to MDI in the prospective cohort of 19 patients. In conclusion, adding miglitol to MDI reduces postprandial glucose levels and attenuates daily glucose fluctuation in type 2 diabetic patients. This trial was registered with UMIN (no. UMIN000005383).

Bariatric Surgery Reduces Oxidative Stress by Blunting 24-h Acute Glucose Fluctuations in Type 2 Diabetic Obese Patients

OBJECTIVEWe evaluated the efficacy of malabsorptive bariatric surgery on daily blood glucose fluctuations and oxidative stress in type 2 diabetic obese patients.RESEARCH DESIGN AND METHODSThe 48-h continuous subcutaneous glucose monitoring was assessed in type 2 diabetic patients before and 1 month after biliopancreatic diversion (BPD) (n = 36), or after diet-induced equivalent weight loss (n = 20). The mean amplitude of glycemic excursions and oxidative stress (nitrotyrosine) were evaluated during continuous subcutaneous glucose monitoring. During a standardized meal, glucagon-like peptide (GLP)-1, glucagon, and insulin were measured.RESULTSFasting and postprandial glucose decreased equally in surgical and diet groups. A marked increase in GLP-1 occurred during the interprandial period in surgical patients toward the diet group (P < 0.01). Glucagon was more suppressed during the interprandial period in surgical patients compared with the diet group (P < 0.01). Mean amplitude of glycemic excursions and nitrotyrosine levels decreased more after BPD than after diet (P < 0.01).CONCLUSIONSOxidative stress reduction after biliopancreatic diversion seems to be related to the regulation of glucose fluctuations resulting from intestinal bypass.

Effects of Helicobacter pylori on blood glucose fluctuation in type 2 diabetic patients

To investigate the effects of Helicobacter pylori (Hp) on blood glucose fluctuation in type 2 diabetic mellitus. 130 type 2 diabetic patients were selected, 72 patients with Hp infection and 58 without Hp infection. Relevant clinical data: blood pressure, body mass index, cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, glycosylated hemoglobin, insulin resistance index, liver function, and renal function were collected. The data of blood glucose levels at 7 time points, 6 - 7 am, 9 - 10 am, 11 - 12 am, 14 - 15 pm, 17 - 18 pm, 19 - 20 pm, and 22 - 23 pm in 3 days, totally 21 data, were collected. And input into the OTDMS data analysis software to evaluate the blood glucose fluctuation indexes: standard deviation of mean blood glucose (SDBG), mean amplitude of glycemic excursions (MAGE), large amplitude of glycemic excursions (LAGE). There were no significant differences in age, course of disease, blood pressure, body mass index, cholesterol, triglyceride, low density lipoprotein cholesterol, glycosylated hemoglobin, and insulin resistance index between these 2 groups (all P > 0.05). The levels of MBG, SDBG, MAGE, LAGE, (mmol/L: 9.0 +/- 1.1 vs 7.6 +/- 0.5, 3.3 +/- 1.1 vs 1.7 +/- 0.5, 6.7 +/- 4.5 vs 3.0 +/- 1.1, 8.6 +/- 3.8 vs 4.2 +/- 1.5, all P < 0.05) and incidence of hypoglycemia [16.6% (12/72) vs 5.1% (3/58), P < 0.05] were all higher in the Hp positive group than in the Hp negative group. Hp infection has a significant effect on the daily blood glucose level and blood glucose fluctuation in the patients with type 2 diabetes.

Average Daily Risk Range-Index of Glycemic Variability-Related Factor in Type 2 Diabetic Inpatients

Background: It is known that chronic sustained hyperglycemia and its consequent oxidative stress causes diabetic complication in type 2 diabetes. It has been further proven that glycemic variability causes oxidative stress. The aim of this study is to measure the average daily risk range (ADDR)-index of glycemic variability, and to evaluate relevant variables. Methods: We measured the blood glucose level of type 2 diabetic patients who were treated with multiple daily injections from January to July, 2008. The blood glucose levels were checked four times a day for 14 days and were conversed according to the ADRR formula. The degree of glycemic variability was categorized into non-fluctuation and fluctuation groups. We collected patient data on age, sex, duration of diabetes, body mass index, HOMAIR, HOMAβcell and HbA1c. Results: A total of 97 patients were enro lled in this study. The mean ag e, duration of diabetes, HbA1c and mean ADRR were 57.6 ± 13.4, 11.5 ±8.5 years, 10.7 ± 2.5%, and 26.6 ± 9.8, respectively. We classified 18.5% of the patients to the non-fluctuation group, and 81.5% to the flu ctuation group. ADRR was significantly correlated with duration of diabetes, fasting and postprandial glucose, fructosamine, HbA1c and BMI and HOMAβcell. In addition, this study confirmed that BMI, HOMAβcell and HbA1c were ADRR-related independent variables. Conclusion: ADRR can be used as an index for blood glucose fluctuation in type 2 diabetic patients. Measuring ADRR in patients with low BMI and a long duration of diabetes is helpful to improve the effectiveness of their care. (Korean Diabetes J 33:31-39, 2009)