Takayoshi Tomofumi, Hirota Yushi, Yamamoto Akane, Yoshimura Kai, Nishikage Seiji, Ueda Mariko, Ogawa Wataru
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan.
Diabetol Int. 2024 Mar 25;15(3):433-438. doi: 10.1007/s13340-024-00709-6. eCollection 2024 Jul.
AIMS/INTRODUCTION: An early-morning elevation of blood glucose levels known as the dawn phenomenon and consequent postbreakfast hyperglycemia occur in some individuals with type 1 diabetes (T1D). Whereas insulin pump therapy can mitigate this phenomenon, some individuals prefer or are limited to alternative treatments. We have now assessed the effectiveness of early-morning administration of rapid-acting insulin for amelioration of the dawn phenomenon in individuals with T1D.
Thirteen individuals with T1D who experienced the dawn phenomenon as determined by continuous glucose monitoring (CGM) and who received a small dose of rapid-acting insulin on waking were included in this retrospective study. We evaluated the change in sensor glucose levels during a 2-h period from before to after breakfast consumed at 0700 h. The change in blood glucose levels during additional time intervals, average daily sensor glucose values, CGM indices, and insulin dose were also evaluated.
The early-morning administration of 0.5-1 unit of rapid-acting insulin was associated with a significant reduction in 2-h glucose variability between before (0700 h) and after breakfast from a median of 90.7-51.0 mg/dL. The glucose variability from 0300 to 0700 or 0900 h was also significantly decreased, from 67.7 to 29.0 mg/dL and from 172.5 to 78.3 mg/dL, respectively. Average sensor glucose levels throughout the day were significantly reduced (from 192.7 to 156.7 mg/dL), as was the daily total insulin dose.
Early-morning administration of rapid-acting insulin effectively managed the dawn phenomenon and subsequent postbreakfast hyperglycemia in individuals with T1D.
The online version contains supplementary material available at 10.1007/s13340-024-00709-6.
目的/引言：1型糖尿病（T1D）患者中，部分人会出现清晨血糖水平升高的黎明现象以及随之而来的早餐后高血糖。尽管胰岛素泵治疗可以缓解这种现象，但一些患者更倾向于或只能选择其他治疗方法。我们现在评估了清晨注射速效胰岛素对改善T1D患者黎明现象的有效性。
本回顾性研究纳入了13名经连续血糖监测（CGM）确定出现黎明现象且醒来时接受小剂量速效胰岛素治疗的T1D患者。我们评估了从早餐前到早餐后2小时期间传感器葡萄糖水平的变化。还评估了其他时间段的血糖水平变化、平均每日传感器葡萄糖值、CGM指标和胰岛素剂量。
清晨注射0.5 - 1单位速效胰岛素与早餐前（07:00）和早餐后2小时血糖变异性显著降低相关，中位数从90.7降至51.0mg/dL。03:00至07:00或09:00的血糖变异性也显著降低，分别从67.7降至29.0mg/dL和从172.5降至78.3mg/dL。全天平均传感器葡萄糖水平显著降低（从192.7降至156.7mg/dL），每日总胰岛素剂量也降低。
清晨注射速效胰岛素可有效控制T1D患者的黎明现象及随后的早餐后高血糖。
在线版本包含可在10.1007/s13340 - 024 - 00709 - 6获取的补充材料。
