Daytime hyperglycemia, nocturnal hypoglycemia remain problems for EDIC cohort
medwireNews: People with type 1 diabetes rarely achieve the current targets for blood glucose control, with nocturnal hypoglycemia remaining a particular concern, shows an analysis of the DCCT/EDIC cohort.
Hypoglycemia “remains an ever-present danger in our cohort,” Rose Gubitosi-Klug (Case Western Reserve University, Cleveland, Ohio, USA) told delegates at the 55th EASD Annual Meeting in Barcelona, Spain.
“We also recognize that there’s a small, highly susceptible subgroup of participants who experience very frequent hypoglycemia.”
The study participants spent 13.1% of their time during the night with blood glucose levels below 70 mg/dL (3.9 mmol/L), which was a 1.6-fold increase over daytime values, and they spent 7.2% of their time below 54 mg/dL (3.0 mmol/L), representing a twofold increase over daytime values.
Although 10.6% of participants did not have any hypoglycemic episodes (≥2 consecutive measurements <54 mg/dL/3.0 mmol/L) during 1 to 2 weeks of blinded continuous glucose monitoring (CGM) and most (60.9%) had between one and 10 episodes, a small proportion, of 7.1%, had 21 or more episodes, so they were having them at least once every day.
The investigators studied 765 EDIC participants who used blinded CGM for between 6.5 and 13.0 days (average 11.9 days); 27% of these people routinely used CGM, 58% used an insulin pump, and 21% used both.
The participants were an average age of 58.9 years at the time of the study, 47% were female, their mean glycated hemoglobin level was 7.8%, and BMI was 29 kg/m2. All had previously participated in the DCCT, with around half being randomly assigned to the intensive therapy group and half to the standard therapy group.
Overall, few of these study participants met the 2019 time in range targets, with only 9% achieving more than 70% of blood glucose readings within the target range of 70–180 mg/dL (3.9–10 mmol/L).
Less than 30% achieved the hypoglycemia targets (<4% and <1% below 70 and 54 mg/dL [3.9 and 3.0 mmol/L], respectively) and only around 20% met the hyperglycemia targets (<25% and <5% above 180 and 250 mg/dL [10.0 and 13.9 mmol/L], respectively).
Achieving the targets was more likely in participants who did not smoke and who used CGM, an insulin pump, or both technologies.
Gubitosi-Klug highlighted the effects of using a low-glucose insulin-suspend system, which was the case for 85 people.
People using this technology were twice as likely to meet the recommended time in target glucose range, at 18.8% compared with 9.0% overall. Their rates of achieving the targets for hypoglycemia and severe hypoglycemia were a respective 40.0% and 47.1% versus 29.8% and 28.0%.
Even their attainment of the hyperglycemia targets was improved, at 35.3% versus 22.5% for the lower target and 31.8% versus 17.3% for the higher target.
The presenter said that the findings highlight the continued need for strategies to reduce nocturnal hypoglycemia and daytime hyperglycemia in people with type 1 diabetes.
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