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Intensive insulin therapy combined with metformin is associated with reduction in both glucose variability and nocturnal hypoglycaemia in patients with type 2 diabetes
Author(s) -
Zhang Yifei,
Zhao Zhiyun,
Wang Shujie,
Zhu Wei,
Jiang Yiran,
Sun Shouyue,
Chen Chen,
Wang Kai,
Mu Liangshan,
Cao Jinyi,
Zhou Yingxia,
Gu Weiqiong,
Hong Jie,
Wang Weiqing,
Ning Guang
Publication year - 2017
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2913
Subject(s) - metformin , medicine , diabetes mellitus , insulin , endocrinology , hypoglycemia , type 2 diabetes , body mass index , continuous glucose monitoring , type 1 diabetes
Abstract Background The effect on glucose variability in patients with intensive insulin therapy has not been fully understood. This observational study investigated the different glucose variability and hypoglycaemia patterns in type 2 diabetes patients treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) with or without metformin administration. Methods During hospitalization, a total of 501 patients with poor glycaemic control and in initial treatment with either CSII alone ( n = 187), CSII + Metformin ( n = 81), MDI alone ( n = 146), or MDI + Metformin ( n = 87) were involved in the final analysis. Data obtained from continuous glucose monitoring were used to assess blood glucose fluctuation and nocturnal hypoglycaemia. Results Among the 4 groups, no difference was found in mean blood glucose levels. Results in parameters reflecting glucose fluctuation: continuous overlapping net glycaemic action in CSII + Metformin and mean amplitude of glycaemic excursions in MDI + Metformin were significantly lower than those in either CSII alone or MDI alone, respectively, even after adjustment ( P = .031 and .006). Frequency of nocturnal hypoglycaemia was significantly decreased in CSII + Metformin as compared with CSII alone (0.6% vs 1.8%) and in MDI + Metformin as compared with MDI alone (1.6% vs 2.3%), with the highest frequency observed in MDI alone and the lowest in CSII + Metformin (all between group P < .001). Consistent results were obtained in between‐group comparisons for hypoglycaemia duration. Subgroup analysis matched with baseline body mass index, and glycated haemoglobin and fasting blood glucose further confirmed these findings. Conclusion Metformin added to initial CSII or MDI therapy is associated with a reduction in both glucose fluctuation and nocturnal hypoglycaemic risk in patients with type 2 diabetes.