scholarly journals Continuous glucose monitoring - proved hypoglycemia in sodium-glucose co-transporter-2 inhibitors - treated type 2 diabetes patients: a link to ketosis development

2019 ◽  
Vol 1 (1) ◽  
pp. 52-69
Author(s):  
Shmuel Levit ◽  
Shmuel Giveon ◽  
Ildar N. Musin ◽  
Royi Barnea ◽  
Ifat Korek-Abadi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Side Effects ◽  
Continuous Glucose Monitoring ◽  
Real Life ◽  
Glucose Monitoring ◽  
Cardiovascular Morbidity And Mortality ◽  
Sensor Glucose ◽  
Group A ◽  
Group B

Background: Latest studies have shown the remarkable ability of sodium-glucose co-transporter-2 inhibitors (SGLT2i) to reduce cardiovascular morbidity and mortality. However, real-life data and the results of several other studies seem to contradict these outcomes, pointing out possibilities of serious side effects. Ketoacidosis (KA) remains one of the most dangerous complications, yet, not fully understood. All of the above urgently requires real-practice data, which may shed some light on side effects of this novel anti-diabetic drug family. Aims: To investigate the real-life rates of hypoglycemia and ketosis (K) in SGLT2i treated patients, using Continuous Glucose Monitoring (CGM) and capillary blood -hydroxybutyrate measurements. Methods: We report the results of a two-year retrospective analysis of 136 Type 2 Diabetes (T2DM) patients, all (100%) treated with a SGLT2i, combined with Metformin or Metformin with Incretin-Based therapy (MT-IBT). CGM recordings were done in 52 persons. In 9 patients (Group A), CGM-proved hypoglycemic episodes were discovered. The rest of 43 patients (Group B) didnt show any hypoglycemia. Three patients in Group A and 11 from Group B were also treated with small doses of basal insulin on admission; the insulin was later discontinued in all patients of Group A and seven patients of Group B . Main characteristics of two groups were subsequently compared. Results: CGM data analysis showed significantly lower average Sensor Glucose (SG) , 7.21.3 vs. 8.21.7 mmol/l, p=0.04, and estimated HbA1c , 6.10.7 vs. 6.81.1%, p=0.02, in Group A patients. We also report three cases of ketosis, proved by elevated capillary -hydroxybutyrate concentrations. Pathophysiological link between frequent hypoglycemia rates (Six patients without insulin treatment (11.5 % in total CGM group of 52 patients)) and ketosis development (Three patients (2.2% in total cohort of 136 participants)) was suggested. Conclusions: More frequent than previously reported rates of hypoglycemia and ketoacidosis were discovered in patients taking SGLT2 inhibitors. Pathophysiological link between the two conditions is assumed. More studies are needed to confirm our hypothesis.

Efficacy and Safety of Empagliflozin as Add-On Therapy in Patients of Type-2 Diabetes Mellitus

2022 ◽  
Vol 9 (1) ◽  
pp. 24-27
Author(s):  
Nauman Wazir ◽  
Shafqat Ur Rehman
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Side Effects ◽  
Glycaemic Control ◽  
Group A ◽  
Group B ◽  
Tract Infections ◽  
Mycotic Infections

OBJECTIVES: To assess efficacy of two doses i.e., 10 mg and 25 mg in lowering the glycated haemoglobin (HbA1C) and fasting blood glucose (FBG) in patients of type 2 diabetes mellitus (T2DM) having suboptimal glycaemic control on maximal doses of Metformin and Sitagliptin, and to see the frequency of its side-effects. METHODOLOGY: The study design was a randomized control trial. Fifty nine adult patients of T2DM who were already on 2000 mg of Metformin and 100 mg of Sitagliptin and were having suboptimal glycaemic control (HBA1C >7% and <12%) were randomized to two groups, one group receiving 10 mg (Group A) and the other group receiving 25 mg of empagliflozin (Group B) as an additional treatment. HbA1C and FBG were taken before and 12 weeks after addition of empagliflozin in both the groups. Side effects of empagliflozin such as urinary tract infections (UTI) and genital mycotic infections were also recorded in both the groups. RESULTS: Total patients in-group A were 31 and their mean age was 51.48±4.29 years. In-group B there were 28 patients and their mean age was 52.39±5.20 years. There was a statistically significant reduction of both HbA1C and FBG in both the groups after empagliflozin treatment; (p=0.000) for both HbA1C and FBG in both the groups. Although numerically UTI and genital mycotic infections were more than pre-treatment numbers, they were not statistically significant (p>0.05). CONCLUSION: Empagliflozin can be safely added to the oral anti-diabetic regimen of patients with type 2 diabetes mellitus who have suboptimal glycaemic control and results in significant improvement in HbA1C.

The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis

2021 ◽  
pp. 1-9
Author(s):  
Tobias Bomholt ◽  
Marianne Rix ◽  
Thomas Almdal ◽  
Filip K. Knop ◽  
Susanne Rosthøj ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Plasma Glucose ◽  
Hemoglobin A1c ◽  
Glucose Monitoring ◽  
Control Group ◽  
Glucose Levels ◽  
Sensor Glucose

<b><i>Introduction:</i></b> The accuracy of hemoglobin A1c (HbA1c) as a glycemic marker in patients with type 2 diabetes (T2D) receiving hemodialysis (HD) remains unknown. To assess accuracy, we compared HbA1c and fructosamine levels with interstitial glucose measured by continuous glucose monitoring (CGM) in patients with T2D receiving HD. <b><i>Methods:</i></b> Thirty patients in the HD group and 36 patients in the control group (T2D and an estimated glomerular filtration rate &#x3e;60 mL/min/1.73 m<sup>2</sup>) completed the study period of 17 weeks. CGM (Ipro2<sup>®</sup>, Medtronic) was performed 5 times for periods of up to 7 days (with 4-week intervals) during a 16-week period. HbA1c (mmol/mol), the estimated mean plasma glucose from HbA1c (eMPGA1c [mmol/L]) and fructosamine (μmol/L) was measured at week 17 and compared with mean sensor glucose levels from CGM. <b><i>Findings:</i></b> In the HD group, mean sensor glucose was 1.4 mmol/L (95% confidence interval [CI]: 1.0–1.8) higher than the eMPGA1c, whereas the difference for controls was 0.1 mmol/L (95% CI: −0.1–[0.4]; <i>p</i> &#x3c; 0.001). Adjusted for mean sensor glucose, HbA1c was lower in the HD group (−7.3 mmol/mol, 95% CI: −10.0–[−4.7]) than in the control group (<i>p</i> &#x3c; 0.001), with no difference detected for fructosamine (<i>p</i> = 0.64). <b><i>Discussion:</i></b> HbA1c evaluated by CGM underestimates plasma glucose levels in patients receiving HD. The underestimation represents a clinical challenge in optimizing glycemic control in the HD population. Fructosamine is unaffected by the factors affecting HbA1c and appears to be more accurate for glycemic monitoring. CGM or fructosamine could thus complement HbA1c in obtaining more accurate glycemic control in this patient group.

Comparison of Efficacy and Safety of Sitagliptin and Glimepiride in Treatment of Type 2 Diabetes Mellitus

2021 ◽  
Vol 15 (10) ◽  
pp. 2800-2803
Author(s):  
Shabir Hussain ◽  
Amjad Mustafa ◽  
Arif Mumtaz ◽  
Ghazala Shaheen ◽  
Fawad Qaiser ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Side Effects ◽  
Drop Out ◽  
Efficacy And Safety ◽  
Significant Drop ◽  
Group A ◽  
Group B

Objective: To compare the efficacy and safety of sitagliptin and glimepiride in treatment of type 2 diabetes mellitus. Design: It was an observational open comparative study. Study Settings: This study was conducted at Department of Pharmacology over 1 year from March 2017 to March 2018 at DHQ Teaching Hospital, Kohat. Material and Methods: Sixty (60) patients were enrolled in the study meeting the inclusion criteria. Tablet glimipiride 1 mg and sitagliptin 100 mg was used as the treatment option. Patients were randomly divided into two groups: group Glimepiride (30 patients; administered glimepiride 2 mg daily) and group Sitagliptin (30 patients; administered sitagliptin 100 mg daily). If glycemic control was not reached then patient was excluded from the study and given further treatment for benefit of the patient. The samples of blood were taken at 12 weeks visit to test HbA1c level, fating blood sugar (FBG) and post prandial glucose (PPG) level. At the time of follow up patient were evaluated for efficacy, safety and tolerability. All collected data was entered then analysed in SPSS version 19.0. Results: A total of 60 patients were enrolled into the study, with 30 in each group. Mean age in sitagliptin group (A) was 45 years, while that of glimeperide group (B) was 47 years. There were 16 males and 14 females in group A, 18 males and 12 females in group B. We found a significant reduction of HbA1C and BMI in group S taking sitagliptin as compared to glimeperide group. (p<0.05) Reduction in FBS was comparable in both the groups. (p>0.05). Side effects in both the groups mostly included hypoglycemia, and vomiting, nausea and abdominal pain. These side effects were mild and did not need stoppage of medication or resulted in drop outs. Conclusion: Sitagliptin as an adjunct to present monotherapy with metformin showed significant drop out in HbA1c, PPG and FBG values after treatment of 12 weeks and was non inferior to glimepiride. However, no sitagliptin taking patients observed any episodes of hypoglycemia. Also weight loss was observed in sitagliptin group as compared to glimepiride group.. Keywords: Glimepiride, Sitagliptin, Efficacy, Safety, Type 2 Diabetes Mellitus

Hemoglobin A1c and Fructosamine Evaluated in Patients with Type 2 Diabetes Receiving Peritoneal Dialysis Using Long-Term Continuous Glucose Monitoring

Nephron ◽  
2021 ◽  
pp. 1-7
Author(s):  
Tobias Bomholt ◽  
Bo Feldt-Rasmussen ◽  
Rizwan Butt ◽  
Rikke Borg ◽  
Mir Hassan Sarwary ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Peritoneal Dialysis ◽  
Continuous Glucose Monitoring ◽  
Plasma Glucose ◽  
Glucose Monitoring ◽  
Control Group ◽  
Glucose Levels ◽  
Sensor Glucose ◽  
Interstitial Glucose

<b><i>Introduction:</i></b> Shortened erythrocyte life span and erythropoietin-stimulating agents may affect hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) levels in patients receiving peritoneal dialysis (PD). We compared HbA<sub>1c</sub> with interstitial glucose measured by continuous glucose monitoring (CGM) in patients with type 2 diabetes receiving PD. <b><i>Methods:</i></b> Fourteen days of CGM (Ipro2, Medtronic) were performed in 23 patients with type 2 diabetes receiving PD and in 23 controls with type 2 diabetes and an estimated glomerular filtration rate over 60 mL/min/1.73 m<sup>2</sup>. Patients were matched on gender and age (±5 years). HbA<sub>1c</sub> (mmol/mol), its derived estimate of mean plasma glucose (eMPG<sub>A1c</sub>) (mmol/L), and fructosamine (µmol/L) were measured at the end of the CGM period and compared with the mean sensor glucose (mmol/L) from CGM. <b><i>Results:</i></b> In the PD group, mean sensor glucose was 0.98 (95% con­fidence interval (CI): 0.43–1.54) mmol/L higher than the eMPG<sub>A1c</sub> compared with the control group (<i>p</i> = 0.002) where glucose levels were nearly identical (−0.05 (95% CI: −0.35–0.25) mmol/L). A significant association was found between fructosamine and mean sensor glucose using linear regression with no difference between slopes (<i>p</i> = 0.89) or y-intercepts (<i>p</i> = 0.28). <b><i>Discussion/Conclusion:</i></b> HbA<sub>1c</sub> underestimates mean plasma glucose levels in patients with type 2 diabetes receiving PD. However, the clinical significance of this finding is undetermined. Fructosamine seems to more accurately reflect glycemic status. CGM or fructosamine could complement HbA<sub>1c</sub> to increase the accuracy of glycemic monitoring in the PD population.

Comparing Patch vs. Pen Bolus Insulin Delivery in Type 2 Diabetes Using Continuous Glucose Monitoring Metrics and Profiles

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 73-LB
Author(s):  
MARY L. JOHNSON ◽  
DARLENE M. DREON ◽  
BRIAN L. LEVY ◽  
SARA RICHTER ◽  
DEBORAH MULLEN ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Insulin Delivery ◽  
Bolus Insulin

973-P: The Feasibility of Continuous Glucose Monitoring in Youth with Type 2 Diabetes Mellitus: A Pilot Study

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 973-P
Author(s):  
ALLISON LAROCHE ◽  
KRISTINA UTZSCHNEIDER ◽  
CATHERINE PIHOKER
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Pilot Study ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring

2180-PUB: Integration of Continuous Glucose Monitoring in Diabetes Self-Management Education for Type 2 Diabetes Improves Glycemic Control

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 2180-PUB
Author(s):  
ADDIE L. FORTMANN ◽  
ALESSANDRA BASTIAN ◽  
CODY J. LENSING ◽  
SHANE HOVERSTEN ◽  
KIMBERLY LUU ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Management Education ◽  
Glucose Monitoring ◽  
Self Management
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