Pratley Richard E, Rosenstock Julio, Heller Simon R, Sinclair Alan, Heine Robert J, Kiljański Jacek, Brusko Cynthia S, Duan Ran, Festa Andreas
1 Florida Hospital and Sanford Burnham Prebys Translational Research Institute, Orlando, FL, USA.
2 Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA.
J Diabetes Sci Technol. 2018 Nov;12(6):1184-1191. doi: 10.1177/1932296818776993. Epub 2018 Jun 12.
Few studies have evaluated continuous glucose monitoring (CGM) in older patients with type 2 diabetes mellitus (T2DM) not using injectable therapy. CGM is useful for investigating hypoglycemia and glycemic variability, which is associated with complications in T2DM.
A CGM substudy of Individualized treatMent aPproach for oldER patIents in a randomized trial in type 2 diabetes Mellitus (IMPERIUM)) was conducted. Patients were vulnerable (moderately ill and/or frail) older (≥65 years) individuals with suboptimally controlled T2DM. Strategy A comprised glucose-dependent therapies (n = 26) with a nonsulfonylurea oral antihyperglycemic medication (OAM) and a glucagon-like peptide-1 receptor agonist as the first injectable. Strategy B comprised non-glucose-dependent therapies (n = 21) with sulfonylurea as the preferred OAM and insulin glargine as the first injectable. Primary endpoints were duration and percentage of time spent with blood glucose (BG) ≤70 mg/dL over 24 hours at week 24.
Duration and percentage of time spent with hypoglycemia at ≤70 mg/dL were similar for Strategy A and Strategy B; glycemic control improved similarly in both arms (LSM change in HbA1c at week 24; A = -1.2%, B = -1.4%). Duration and percentage time spent with euglycemia and hyperglycemia were also similar in both arms. However, Strategy A was associated with lower within-day (21.1 ± 1.2 vs 25.1 ± 1.4, P = .046) and between-day (5.4 ± 1.0 vs 9.1 ± 1.3, P = .038) BG variability (coefficient of variance [LSM ± SE]) at week 24.
This CGM substudy in older patients with T2DM showed lower within- and between-day BG variability with glucose-dependent therapies but similar HbA1c reductions and hypoglycemia duration with glucose-independent strategies.
很少有研究评估未使用注射治疗的老年2型糖尿病（T2DM）患者的持续葡萄糖监测（CGM）情况。CGM有助于研究低血糖和血糖变异性，而血糖变异性与T2DM并发症相关。
开展了一项针对老年患者个体化治疗方案（IMPERIUM）的2型糖尿病随机试验中的CGM子研究。患者为脆弱的（中度患病和/或虚弱的）老年（≥65岁）个体，T2DM控制不佳。策略A包括基于血糖的治疗（n = 26），使用非磺脲类口服降糖药（OAM）和胰高血糖素样肽-1受体激动剂作为首剂注射药物。策略B包括非基于血糖的治疗（n = 21），以磺脲类作为首选OAM，甘精胰岛素作为首剂注射药物。主要终点是第24周时24小时内血糖（BG）≤70 mg/dL的持续时间和所占时间百分比。
策略A和策略B在≤70 mg/dL时低血糖的持续时间和所占时间百分比相似；两组的血糖控制改善情况相似（第24周时HbA1c的LSM变化；A组=-1.2%，B组=-1.4%）。两组在血糖正常和高血糖状态下的持续时间和所占时间百分比也相似。然而，在第24周时，策略A的日内（21.1±1.2对25.1±1.4，P = 0.046）和日间（5.4±1.0对9.1±1.3，P = 0.038）BG变异性（变异系数[LSM±SE]）较低。
这项针对老年T2DM患者的CGM子研究表明，基于血糖的治疗方案的日内和日间BG变异性较低，但与非血糖依赖策略相比，HbA1c降低幅度和低血糖持续时间相似。
