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Contribution of basal and postprandial hyperglycaemia in type 2 diabetes patients treated by an intensified insulin regimen: Impact of pump therapy in the OPT2mise trial
Author(s) -
Reznik Yves,
Habteab Aklilu,
Castaneda Javier,
Shin John,
Joubert Michael
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13398
Subject(s) - postprandial , medicine , area under the curve , basal (medicine) , regimen , diabetes mellitus , continuous glucose monitoring , insulin , type 1 diabetes , gastroenterology , analysis of variance , group b , randomized controlled trial , urology , endocrinology
Aims The relative contribution of basal hyperglycaemia (BHG) and postprandial hyperglycaemia (PPHG) in type 2 diabetes patients treated with multiple daily injections (MDI) of insulin is poorly documented. In this study, the BHG and PPHG of patients from the OPT2mise study who were initially treated with MDI were assessed before randomization and again after 6 months of continuous subcutaneous insulin infusion (CSII). Materials and Methods Blinded continuous glucose monitoring (CGM) data were collected in 259 MDI patients after completion of an 8‐week run‐in period. The hyperglycaemic area under the curve (AUC) during the 24‐hour basal period (AUC‐B) and the postprandial period (AUC‐P) were compared with analysis of variance based on contribution to total hyperglycaemia in HbA1c groups (Group 1, <8%; Group 2, 8%‐8.4%; Group 3, 8.5%‐8.9%; Group 4, 9%‐9.4%; Group 5, ≥9.5%). Changes in AUC‐B and AUC‐P were assessed after 6 months of pump therapy in 131 randomized participants with available CGM recordings. Results In patients undergoing MDI therapy, AUC‐B was 21.6% to 54.8% lower in Group 4 to 1 ( P = .0138 and P = .0002, respectively) in comparison to Group 5. In contrast, AUC‐P did not differ among HbA1c groups ( P = .1009). HbA1c correlated with AUC‐B, but not with AUC‐P. After switching to CSII, AUC‐B and AUC‐P decreased by 21% and 17%, respectively. When comparing responders with non‐responders to CSII therapy, no between‐group differences were observed in AUC‐B and AUC‐P. Conclusions Basal hyperglycaemia is the major determinant of overall exposure to hyperglycaemia in type 2 diabetes with MDI failure.