High Blood Glucose Variability Research Articles

High blood glucose variability may predict poor outcomes in patients with spontaneous cerebellar hemorrhage undergoing surgical operation: a retrospective study

BackgroundElevated blood glucose (BG) variability has been reported as an independent risk factor for poor prognosis in a variety of diseases. This study aimed to investigate the association between BG variability and clinical outcomes in patients with spontaneous cerebellar hemorrhage (SCH) undergoing surgical operation.MethodsThis retrospective cohort study of the consecutive patients admitted to the department of Neurosurgery, the Affiliated Hospital of Qingdao University between January 2014 and June 2022 with the diagnosis of SCH underwent surgical intervention. BG analysis was continuously and routinely performed. BG variability was represented by the standard deviation (SD) of the serial measurements within the first 7 days. The general characteristics, imageological information, blood glucose level, and surgical information were reviewed and compared through medical records.ResultsA total of 115 patients (65 male and 50 female) were enrolled. Out of all 115 patients, the overall clinical outcomes according to the modified Rankin Scale (mRS) were poor (mRS 3–6) in 31 patients (26.96%) and good (mRS 0–2) in 84 patients (73.04%). Twelve of the 115 patients died during hospitalization, and the mortality rate was 10.43%. Multivariate logistic regression analysis showed that SD of BG (odds ratio (OR), 4.717; 95% confidence interval (CI), 1.054–21.115; P = 0.043), GCS (OR, 0.563; 95% CI, 0.330–0.958; P = 0.034), and hematoma volume (OR, 1.395; 95% CI, 1.118–1.748; P = 0.003) were significant predictors. The area under the ROC curve of SD of BG was 0.911 (95% CI, 0.850–0.973; P < 0.001) with a sensitivity and specificity of 90.3% and 83.3%, respectively, and the cut-off value was 1.736.ConclusionsHigh BG Variability is independently correlated with the 6-month poor outcomes in patients with SCH undergoing surgical operation.

A novel hypoglycemia alarm framework for type 2 diabetes with high glycemic variability.

In patients with type 2 diabetes (T2D), accurate prediction of hypoglycemic events is crucial for maintaining glycemic control and reducing their frequency. However, individuals with high blood glucose variability experience significant fluctuations over time, posing a challenge for early warning models that rely on static features. This article proposes a novel hypoglycemia early alarm framework based on dynamic feature selection. The framework incorporates domain knowledge and introduces multi-scale blood glucose features, including predicted values, essential for early warnings. To address the complexity of the feature matrix, a dynamic feature selection mechanism (Relief-SVM-RFE) is designed to effectively eliminate redundancy. Furthermore, the framework employs online updates for the random forest model, enhancing the learning of more relevant features. The effectiveness of the framework was evaluated using a clinical dataset. For T2D patients with a high coefficient of variation (CV), the framework achieved a sensitivity of 81.15% and specificity of 98.14%, accurately predicting most hypoglycemic events. Notably, the proposed method outperformed other existing approaches. These results indicate the feasibility of anticipating hypoglycemic events in T2D patients with high CV using this innovative framework.

Correlation between long-term glycemic variability and cognitive function in middle-aged and elderly patients with type 2 diabetes mellitus: a retrospective study.

To investigate the correlation between long-term glycemic variability and cognitive function in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM). This retrospective analysis includes 222 patients hospitalized at Second Affiliated Hospital of Anhui Medical University from June 2021 to June 2023. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). All patients were categorized into the MCI group and the non-MCI group based on their MoCA score. Long-term blood glucose fluctuations were measured using glycated hemoglobin A1c standard deviation (HbA1c-SD) and fasting plasma glucose standard deviation (FPG-SD). The study compared general clinical data, blood biochemical indicators, and glycemic variability indicators between the two groups. The differences between the groups were compared using t-test, Chi-Square Test, or Mann-Whitney U test. Kendall's correlation analysis, multivariate logistic regression analysis and ROC curve correlation analysis were further used to analyze the correlation and diagnostic power. The differences in age, MoCA scores, MMSE scores, HOMA-β, HbA1c-M, HbA1c-SD, FPG-M, FPG-SD, eGFR, Smoking, GLP-1RA and SGLT-2i usage were statistically significant between the two groups (P<0.05). Kendall's correlation analysis showed that age, HbA1c-M, HbA1c-SD, FPG-M, and FPG-SD was negatively correlated with MoCA scores; meanwhile, the HOMA-β, and eGFR was positively correlated with MoCA scores. Multiple logistic regression analysis revealed that HbA1c-SD, FPG-SD and Smoking were risk factors for cognitive dysfunction, while eGFR, GLP-1RA and SGLT-2i usage was a protective effect. The area under the curve (AUC) values for predicting MCI prevalence were 0.830 (95% CI [0.774-0.877], P<0.001) for HbA1c-SD, 0.791 (95% CI [0.655-0.808], P<0.001) for FPG-SD, and 0.698 (95% CI [0.633-0.757], P<0.001) for eGFR. The optimal diagnostic values were 0.91, 1.32, and 74.81 ml/min/1.73 m2 for HbA1c-SD, FPG-SD, and eGFR, respectively. Cognitive function in middle-aged and elderly T2DM patients is influenced by long-term blood glucose variability, with poorer cognitive function observed in individuals with higher blood glucose variability. The impact of HbA1c-SD on MCI exhibited a greater magnitude compared to that of PFG-SD and smoking. Additionally, renal function, GLP-1RA and SGLT-2i usage exert positive effects on cognitive function.

58-LB: Associations between Diabetes Distress and CGM Metrics in Adults in the T1D Exchange Registry

Research on diabetes distress in continuous glucose monitor (CGM) users with T1D is divided. Some studies suggest CGM users experience less distress compared to non-users, whereas other studies find no differences in distress. While research shows higher distress is related to higher HbA1c, more work is needed to understand how distress is related to CGM metrics. Thus, we recruited adult CGM users with T1D (n = 199) from the T1D Exchange Registry to complete an online survey about diabetes characteristics and a screener of diabetes distress (DDS-2). CGM metrics (defined in Table 1) were computed from CGM data within 12 months prior to survey completion. Participants were grouped into lower (DDS-2 &amp;lt; 3, n = 120) or higher (DDS-2 ≥ 3, n = 79) diabetes distress. We used Welch’s t-tests to compare mean differences in blood glucose (BG) experiences and CGM metrics between participants with lower and higher diabetes distress. As shown in Table 1, participants with higher diabetes distress reported higher HbA1c, and - via CGM metrics - experienced more time in higher BG ranges and less time within standard target ranges, had higher blood glucose variability, and had higher GMI compared to those with lower distress. Associations between distress and CGM metrics replicated in a MANCOVA after adjusting for duration of T1D. Our results suggest, in CGM users, higher perceived diabetes distress is associated with more time in hyperglycemia. Disclosure C. S. Kelly: None. H. Nguyen: None. K. S. M. Chapman: None. E. M. Cornelius: None. M. Peter: None. W. Wolf: None.

A surgical nursing perspective analysis of glucose variability in BCLC stage B-C hepatocellular carcinoma patients with and without T2D within 1 year of hepatectomy: a retrospective cohort study from 2016 to 2020.

Previous research has reported that variability in glucose levels is associated with a variety of patient characteristics in colon cancer. However, relevant research is still lacking in relation to hepatocellular carcinoma (HCC). A total of 95 HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage B-C who underwent liver resection at the Eastern Hepatobiliary Surgery Hospital and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included in this study. The patients were divided into 2 groups with type 2 diabetes (T2D) and without T2D. The primary outcome variable was blood glucose variability at 1 month and within 1 year of HCC surgery. In this study, the age of patients with T2D was greater than that of patients without T2D (mean age: 70.3±8.45 vs. 60.4±11.27 years, P=0.031). Compared to the patients without T2D, those with T2D had higher blood glucose measurements within 1 month (33 vs. 7) and 1 year (46.5 vs. 22.5, P<0.001) of surgery. The T2D patients and non-T2D patients did not differ in terms of chemotherapy medication or other characteristics. Among the 95 patients with BCLC stage B-C HCC, those with T2D had higher variability in glucose levels (P<0.001) than those without T2D within 1 month of surgery [standard deviation (SD) =46.43 mg/dL, coefficient of variation (CV) =23.5% vs. SD =21.56 mg/dL, CV =13.21%], and within 1 year of surgery (SD =42.49 mg/dL, CV =26.14% vs. SD =20.45 mg/dL, CV =17.36%). A correlation was found between a lower body mass index and higher variability in glucose levels within 1 month of surgery among patients with T2D [SD (r=-0.431, P<0.05) and CV (r=-0.464, P<0.01)]. A higher preoperative blood glucose level in T2D patients was correlated with a higher blood glucose variability within 1 year of surgery (r=0.435, P<0.01). Variability in glucose levels was weakly correlated with the demographic and clinical characteristics of patients who do not have T2D. HCC patients with T2D in BCLC stage B-C showed greater variability in glucose levels within 1 month and 1 year of surgery. Preoperative hyperglycemia, insulin use, and a lower cumulative dose of steroids were clinical features correlated with a higher variability in glucose levels in T2D patients.

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.

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.

Fibre-enriched buckwheat pasta modifies blood glucose response compared to corn pasta in individuals with type 1 diabetes and celiac disease: Acute randomized controlled trial

AimPeople with type 1 diabetes and celiac disease (T1D&CD) have high blood glucose variability. Processed gluten-free foods have shown to induce a worse metabolic profile whereas naturally gluten-free foods may represent healthier options. On the other hand, dietary fibre has shown to reduce postprandial glycemic excursions in individuals with diabetes. Thus, we evaluated the acute effect of fibre-enriched buckwheat (FBP) and corn pasta (CP) on postprandial blood glucose response (PP-BGR). MethodsTen adult patients with T1D&CD consumed two meals with the same amount of carbohydrate while differing only for pasta type (FBP or CP) preceded by the same insulin bolus. Participants utilized continuous glucose monitoring (CGM) and data over 6 h after meal were analyzed. ResultsPP-BGR differed between the two meals, being significantly lower in the first period (0–3 h) after the CP than the FBP meal (iAUC: −38 ± 158 vs. 305 ± 209 mmol/L · 180 min, p = 0.040), whereas significantly higher in the second period (3–6 h) after the CP than the FBP meal (iAUC: 432 ± 153 vs. 308 ± 252 mmol/L · 180 min, p = 0.030). Overall, a less variable postprandial profile was observed after FBP than CP consumption. ConclusionsIn individuals with T1D&CD, the acute consumption of FBP induces significant differences in PP-BGR compared with CP that may be clinically relevant.

High blood glucose variability is associated with bacteremia and mortality in patients hospitalized with acute infection.

Limited data are available regarding the association between glucose levels variability (GV) and outcomes of patients hospitalized with acute infectious diseases. To determine the association between GV and bacteremia, length of stay (LOS) and mortality. A retrospective study of patients hospitalized in departments of medicine with respiratory tract, urinary tract and skin and soft tissue infections during 2011-17. GV was assessed by the coefficient of variation (CV) of glucose levels during hospitalization and was divided into tertiles (CV ≤ 16%, 17-29%, >29%). LOS, bacteremia rates and all-cause mortality (30 days, 90 days and after 5 years) were evaluated for the patients with and without DM according the three GV categories. The study consisted of 1485 patients, 838 (56%) were diabetic. There was no significant association between GV and LOS. Bacteremia rates were higher in the upper GV tertile compared with the lower one (6% vs. 2%, P = 0.007). Mid and upper tertiles compared with the lower one were significantly associated with increased 30-day mortality (13% vs. 5%, P = 0.005; and 40% vs. 5%, P = 0.002, respectively). A decreased 5 years survival was observed for both diabetic and non-diabetic patients in the mid and upper GV tertiles [adjusted HRs 0.8 (95% CI, 0.6-1.04) and 0.6 (95% CI, 0.5-0.9) in diabetic patients and 0.7 (95% CI, 0.5-0.9) and 0.5 (95% CI, 0.3-0.7) in the non-diabetic ones]. In diabetic and non-diabetic patients, hospitalized in non-ICU setting with acute infectious diseases, increased GV is associated with increased risk of bacteremia, short and long-term mortality.

Impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris at 6 months follow-up

BackgroundWe explored the impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris (SAP) at 6months follow-up. MethodsFrom May 2015 to April 2016, a total of 746 patients with SAP were divided to high glycemic variability group (H group) (n=261) and low glycemic variability group (L group) (n=485). The primary end point was incidence of periprocedural myocardial infarction and MACE at 6months follow-up. ResultsThe occurrence of periprocedural myocardial infarction occurred in 18.8% of patients in H group and in 12.4% in L group (P=0.03). The incidence of MACE at 6months follow-up was 9.6% in H group and 4.5% in L group (P=0.01). Multivariable analysis suggested that high glycemic variability conferred a 53% risk increment of 6months follow-up MACE (odds ratio 2.13, 95% confidence interval 1.85–5.38; P=0.01). ConclusionsThe trial shows that higher blood glucose variability was correlated with higher incidence of periprocedural myocardial infarction and MACE at 6months follow-up.

Association between glycemic variability and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome during 30-day follow-up

BackgroundWe explored the association between glycemic variability and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS) during 30-day follow-up. MethodsFrom May 2013 to April 2015, a total of 864 patients with ACS were divided to high glycemic variability group (H group) (n=285) and low glycemic variability group (L group) (n=579). The primary end point was a 30-day incidence of MACCE. Secondary end points were the incidence of atrial fibrillation (AF) during hospitalization and length of hospital stay. ResultsThe primary end point occurred in 15.2% of patients in H group and in 9.7% in L group (p=0.03). The incidence of AF during hospitalization was 14.5% in H group and 8.9% in L group (p=0.02). Compared with the L group, the H group extended the length of hospital stay. Multivariable analysis suggested that high glycemic variability conferred a 57% risk increment of 30-day MACCE (odds ratio 1.97, 95% confidence interval 1.32–6.86; p=0.02). ConclusionThe trial shows that higher blood glucose variability was correlated with higher incidence of MACCE, AF and longer length of stay.

Incidence, characteristics and impact of hypoglycaemia in patients receiving intensified treatment for inadequately controlled type 2 diabetes mellitus.

With the intensification of antidiabetic treatment, there is an increasing risk of hypoglycaemia. We aimed to determine incidence, characteristics and outcomes. Prospective, observational, multicenter cohort study. The included 3810 patients with type 2 diabetes had their treatment intensified at baseline. The incidence of hypoglycaemia was 11.4% per year with 4.2 ± 4.4 episodes per patient. Hypoglycaemia was more frequent in patients with high blood glucose variability. Predictors were heart failure (odds ratio: 1.66; 95% confidence interval: 1.20-2.29) and insulin use (odds ratio: 4.03; 95% confidence interval: 3.05-5.33), with dipeptidyl peptidase-4 inhibitors being associated with reduced risk (odds ratio: 0.69; 95% confidence interval: 0.53-0.89). Macrovascular events were more frequent among patients reporting severe episodes of hypoglycaemia (odds ratio: 3.39; 95% confidence interval: 1.32-8.73). Microvascular events were more frequent in patients with non-severe episodes (odds ratio: 1.92; 95% confidence interval: 1.49-2.49). Case-by-case evaluation of patients as well as appropriate selection of antidiabetic pharmacotherapy and blood glucose treatment goals could maximize the benefits while reducing the risks of antidiabetic treatment.

Continuous glucose monitoring technologies: state of the art and future perspectives in view of artificial pancreas

Continuous glucose monitoring (CGM) - a relatively new and rapidly developing technology of optimization glycemic control in patients with diabetes. The efficiency of the use of CGM for improving glycemic level in many clinical situations (asymptomatic hypoglycemia, high blood glucose variability, etc.). In the long term, CGM treated as a mandatory component of the «artificial pancreas» - an insulin pump with a closed-loop control infusion of insulin depending on the concentration of glucose in the blood. However, the modern technology such as CGM could not be used, as a data source to control closed-loop insulin pump (artificial pancreas), because of the significant limitations and lack of precision. In further development of technologies CGM, obviously, will address three main objectives: increased service life of sensors for the detection of glucose, improving the accuracy of measurement results and ease of use for patients. This article describes the main technological solutions of modern devices for CGM and promising directions for further developments in this field, their potential advantages and disadvantages, including in the light of the prospects for further integrating them into an «artificial pancreas».

Association between blood glucose variability and coronary plaque instability in patients with acute coronary syndromes.

BackgroundBlood glucose variability is receiving considerable attention as a new risk factor for coronary artery disease. This study aimed to investigate the association between blood glucose variability and coronary plaque tissue characteristics.MethodsIn 57 patients with acute coronary syndrome, integrated backscatter intravascular ultrasound (IB-IVUS) and gray-scale IVUS were performed before balloon dilatation or stent implantation in the culprit vessels. Standard IVUS indices were evaluated for volume index (volume/length), and plaque components were measured by IB-IVUS for percent tissue volume. In addition to conventional glucose indicators, blood glucose variability in a stable state was determined by calculating the mean amplitude of glycemic excursions (MAGE) using a continuous glucose monitoring system.ResultsHigher MAGE values were significantly correlated with larger percent plaque volumes (r = 0.32, p = 0.015), and increased lipid (r = 0.44, p = 0.0006) and decreased fibrous (r = −0.45, p = 0.0005) plaque components. In contrast, HbA1c or fasting plasma glucose values were not significantly correlated with plaque volumes and percent plaque components. Homeostasis model assessment of insulin resistance values were positively correlated with vessel (r = 0.35, p = 0.007) and plaque (r = 0.27, p = 0.046) volumes, but not with percent plaque components. In multiple regression analysis, higher MAGE values were independently associated with increased lipid (β = 0.80, p = 0.0035) and decreased fibrous (β = -0.79, p = 0.0034) contents in coronary plaques.ConclusionsAmong all glucose indicators studied, only higher blood glucose variability was an independent determinant of increased lipid and decreased fibrous contents with larger plaque burden, suggesting blood glucose variability as one of the important factors related to coronary plaque vulnerability.

Hypoglycemia in noncritically ill patients receiving total parenteral nutrition: A multicenter study.: (Study group on the problem of hyperglycemia in parenteral nutrition; Nutrition area of the Spanish Society of Endocrinology and Nutrition)

ObjectiveHypoglycemia is a common problem among hospitalized patients. Treatment of hyperglycemia with insulin is potentially associated with an increased risk for hypoglycemia. The aim of this study was to determine the prevalence and predictors of hypoglycemia (capillary blood glucose <70 mg/dL) in hospitalized patients receiving total parenteral nutrition (TPN). MethodsThis prospective multicenter study involved 19 Spanish hospitals. Noncritically ill adults who were prescribed TPN were included, thus enabling us to collect data on capillary blood glucose and insulin dosage. ResultsThe study included 605 patients of whom 6.8% (n = 41) had at least one capillary blood glucose <70 mg/dL and 2.6% (n = 16) had symptomatic hypoglycemia. The total number of hypoglycemic episodes per 100 d of TPN was 0.82. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes, a lower body mass index (BMI), and treatment with intravenous (IV) insulin. Patients with hypoglycemia also had a significantly longer hospital length of stay, PN duration, higher blood glucose variability, and a higher insulin dose. Multiple logistic regression analysis showed that a lower BMI, high blood glucose variability, and TPN duration were risk factors for hypoglycemia. Use of IV insulin and blood glucose variability were predictors of symptomatic hypoglycemia. ConclusionsThe occurrence of hypoglycemia in noncritically ill patients receiving PN is low. A lower BMI and a greater blood glucose variability and TPN duration are factors associated with the risk for hypoglycemia. IV insulin and glucose variability were predictors of symptomatic hypoglycemia.

Increasing Blood Glucose Variability Heralds Hypoglycemia in the Critically Ill

Control of hyperglycemia improves outcomes, but increases the risk of hypoglycemia. Recent evidence suggests that blood glucose variability (BGV) is more closely associated with mortality than either isolated or mean BG. We hypothesized that differences in BGV over time are associated with hypoglycemia and can be utilized to estimate risk of hypoglycemia (<50 mg/dL). Patients treated with intravenous insulin in the Surgical Intensive Care Unit of a tertiary care center formed the retrospective cohort. Exclusion criteria included death within 24 h of admission. We describe BGV in patients over time and its temporal relationship to hypoglycemic events. The risk of hypoglycemia for each BG measurement was estimated in a multivariable regression model. Predictors were measures of BGV, infusions of dextrose and vasopressors, patient demographics, illness severity, and BG measurements. A total of 66,592 BG measurements were collected on 1392 patients. Hypoglycemia occurred in 154 patients (11.1%). Patient BGV fluctuated over time, and increased in the 24 h preceding a hypoglycemic event. In crude and adjusted analyses, higher BGV was positively associated with a hypoglycemia (OR 1.41, P < 0.001). Previous hypoglycemic events and time since previous BG measurement were also positively associated with hypoglycemic events. Severity of illness, vasopressor use, and diabetes were not independently associated with hypoglycemia. BGV increases in the 24 h preceding hypoglycemia, and patients are at increased risk during periods of elevated BG variability. Prospective measurement of variability may identify periods of increased risk for hypoglycemia, and provide an opportunity to mitigate this risk.

High blood glucose variability in acute phase is one of the most important risk factors relating to the outcome in acutely ill severe patients with glucose intolerance

High blood glucose (BG) variability is considered to affect the prognosis of acutely ill patients. However, the significance of BG variability is not clearly elucidated. We investigated the significance of BG variability with a bedside-type artificial pancreas (AP).

Clinical experience with tight glucose control by intensive insulin therapy

To describe the current status and the clinical data related to the effects of tight glucose control by intensive insulin therapy in critically ill patients. Review article. University hospital. Medical and surgical critically ill patients in whom a correlation between blood glucose and outcome variables were searched. Tight glucose control by intensive insulin therapy. In contrast to the decreases in mortality and to low severity of adverse effects reported when insulin rate was titrated to keep blood glucose between 80 and 110 mg/dL, the benefits were not confirmed in multicenter prospective studies. Retrospective data found an association between a mean blood glucose level of <140-150 mg/dL and improved outcome. Currently unanswered issues include the optimal target for blood glucose, the effects of high blood glucose variability, the risks and hazards of hypoglycemia, and the potential influence of the underlying disorder on the effects of tight glucose control. Recommendations regarding the practical aspects of tight glucose control by intensive insulin therapy cannot be presently issued. An intermediate target level for blood glucose of 140-180 mg/dL seems to be associated with the lowest risk-to-benefit ratio.

Long-term use of continuous subcutaneous insulin infusion

The routine clinical use of insulin pump therapy (continuous subcutaneous insulin infusion, CSII) is very variable throughout the world – from 20% to less than 1% of type 1 diabetic subjects. One reason for this is the continued confusion about its best use. Here, I suggest that the main indications are frequent unpredictable hypoglycaemia, and the combination of an elevated HbAlc and high blood glucose variability, in spite of best attempts to improve control with multiple daily insulin injections (MDI). The largest improvements in HbAlc on switching from MDI to CSII are seen in the worst controlled patients on injections, and thus when insulin pump therapy is used in this target group it is more effective then previously thought and likely to deliver a major reduction in the risk of developing microvascular disease.

Biological and behavioural determinants of the frequency of mild, biochemical hypoglycaemia in patients with Type 1 diabetes on multiple insulin injection therapy

Background Severe hypoglycaemic episodes are an important source of morbidity in people with Type 1 diabetes. The occurrence of severe hypoglycaemia is strongly related to the frequency of low blood glucose readings. The aim of this exploratory study was to identify determinants of the frequency of mild, biochemical hypoglycaemia in patients with Type 1 diabetes treated with multiple insulin injection therapy. Methods We studied 31 patients with Type 1 diabetes in reasonable glycaemic control (HbA1c≤8.3%) during multiple injection therapy. The study had a prospective, observational design. We used standardised home blood glucose monitoring (HBGM) diaries to assess the frequency of hypoglycaemia (HBGM readings<3.5 mmol/L) over a period of 6 weeks. Potential determinants studied included biological factors, self-management factors (including weekly total physical activity and vigorous physical activity), psychological factors (including psychological distress) and mediating factors [average and standard deviation (SD) of the HBGM readings and self-reported hypoglycaemia awareness]. Results Determinants of mild hypoglycaemia frequency identified in univariate regression analyses were: SD and mean of HBGM (β 0.6, p=0.001 and β −0.6, p=0.001), diabetes duration (β 0.5, p=0.008) and self-reported hypoglycaemia unawareness (β −0.5, p=0.003). A trend was observed for performance of vigorous physical activities (β 0.3, p=0.06) and external eating behaviour (β −0.3, p=0.1). These relations were confirmed in multivariate analyses. Conclusions Patients with Type 1 diabetes who have a high blood glucose variability and low average blood glucose concentration, diabetes of long duration, low body mass index, self-reported impaired awareness of hypoglycaemia and those participating in vigorous physical activities, specifically require interventions aimed at preventing hypoglycaemia. Copyright © 2000 John Wiley & Sons, Ltd.