Department of Endocrinology and Diabetology, Côte de Nacre Regional Hospital Center, Caen, France.
University of Caen Basse-Normandie, Medical School, Caen, France.
Diabetes Obes Metab. 2018 Oct;20(10):2435-2441. doi: 10.1111/dom.13398. Epub 2018 Jul 6.
The relative contribution of basal hyperglycaemia (BHG) and postprandial hyperglycaemia (PPHG) in type 2 diabetes patients treated with multiple daily injections (MDI) of insulin is poorly documented. In this study, the BHG and PPHG of patients from the OPT2mise study who were initially treated with MDI were assessed before randomization and again after 6 months of continuous subcutaneous insulin infusion (CSII).
Blinded continuous glucose monitoring (CGM) data were collected in 259 MDI patients after completion of an 8-week run-in period. The hyperglycaemic area under the curve (AUC) during the 24-hour basal period (AUC-B) and the postprandial period (AUC-P) were compared with analysis of variance based on contribution to total hyperglycaemia in HbA1c groups (Group 1, <8%; Group 2, 8%-8.4%; Group 3, 8.5%-8.9%; Group 4, 9%-9.4%; Group 5, ≥9.5%). Changes in AUC-B and AUC-P were assessed after 6 months of pump therapy in 131 randomized participants with available CGM recordings.
In patients undergoing MDI therapy, AUC-B was 21.6% to 54.8% lower in Group 4 to 1 (P = .0138 and P = .0002, respectively) in comparison to Group 5. In contrast, AUC-P did not differ among HbA1c groups (P = .1009). HbA1c correlated with AUC-B, but not with AUC-P. After switching to CSII, AUC-B and AUC-P decreased by 21% and 17%, respectively. When comparing responders with non-responders to CSII therapy, no between-group differences were observed in AUC-B and AUC-P.
Basal hyperglycaemia is the major determinant of overall exposure to hyperglycaemia in type 2 diabetes with MDI failure.
多项胰岛素每日注射（MDI）治疗的 2 型糖尿病患者中，基础高血糖（BHG）和餐后高血糖（PPHG）的相对贡献尚未得到充分记录。在这项研究中，评估了最初接受 MDI 治疗的 OPT2mise 研究患者在随机分组前和连续皮下胰岛素输注（CSII）治疗 6 个月后的 BHG 和 PPHG。
在 259 名 MDI 患者完成 8 周导入期后，收集了盲法连续血糖监测（CGM）数据。通过基于 HbA1c 组（组 1，<8%；组 2，8%-8.4%；组 3，8.5%-8.9%；组 4，9%-9.4%；组 5，≥9.5%）的总高血糖贡献，对 24 小时基础期（AUC-B）和餐后期（AUC-P）的高血糖面积下曲线（AUC）进行了比较。在 131 名有 CGM 记录的随机参与者中，评估了泵治疗 6 个月后 AUC-B 和 AUC-P 的变化。
在接受 MDI 治疗的患者中，与组 5 相比，组 4 至 1（P =.0138 和 P =.0002）的 AUC-B 分别低 21.6%至 54.8%。相比之下，HbA1c 组之间的 AUC-P 没有差异（P =.1009）。HbA1c 与 AUC-B 相关，但与 AUC-P 无关。转换为 CSII 后，AUC-B 和 AUC-P 分别降低了 21%和 17%。当比较 CSII 治疗的应答者与非应答者时，AUC-B 和 AUC-P 两组之间没有差异。
在 MDI 治疗失败的 2 型糖尿病患者中，基础高血糖是总体高血糖暴露的主要决定因素。
