Cardiovascular Adverse Outcomes as Challenges on Glycemic Variability Among Patients with Type 2 Diabetes on Intensive Insulin Therapy: The Role of Medical Nutrition Therapy with Automatic Snacking

The glycemic variability (GV) is the fluctuation of the blood glucose (BG) in relation to the daily mean BG or mean glycosylated hemoglobin (HbA1c). BG oscillations can be influenced by the type of food and timing of intake, activity, psychological condition (fear of hypoglycemia), and systemic hormonal cross-talking between insulin and glucagon. Pharmacologically, these BG oscillations can be affected by the regulators of insulin secretion like sulfonylurea and insulin. The increase in GV with very high and very low BG excursions has been associated with the development of macrovascular and microvascular complications among type 2 diabetes mellitus (DM) patients. Increased mortality has been demonstrated in the past among elderly patients on intensive insulin therapy due to severe hypoglycemia. Prompt intake of glucose has obviously compromised glycemic control and worsens the GV. Automatic snacking (AS) as a part of medical nutrition therapy (MNT) is the provision of snacks 2 h after meals which are taken even in the absence of hunger. This review will showcase our published papers among patients with type 2 DM where AS was instituted to obtain long-term glycemic control and prevent the occurrence of fatal postprandial hypoglycemia. Although, further research is needed, AS is a promising dietary management to address GV in type 2 DM patients on intensive insulin therapy.