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Global assessment for quality and safety of control in type 2 diabetic patients
Author(s) -
Monnier L.,
Colette C.,
Lapinski H.
Publication year - 2004
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2004.01280.x
Subject(s) - quality (philosophy) , type 2 diabetes , medicine , control (management) , diabetes mellitus , computer science , endocrinology , physics , artificial intelligence , quantum mechanics
Background HbA1c (glycated haemoglobin) suffers from obvious limitations in type 2 diabetic patients at risk of hypoglycaemia or requiring rapid therapeutic adjustments. This study was conducted to discern whether the monitoring of one particular plasma glucose (PG) value of the diurnal profile can be used in such situations. Design Four diurnal PG concentrations (at 08:00, 11:00, 14:00 and 17:00 h) were measured in standardized conditions in 480 (246 men, 234 women) noninsulin‐using type 2 diabetic patients. Sensitivities for predicting treatment success, i.e. HbA1c < 7%, with a specificity ≥ 90% were calculated and compared using receiver‐operating characteristic (ROC) curves. Results The probabilities (areas under ROC curves) for predicting HbA1c < 7% were significantly higher at 11:00, 14:00 and 17:00 h than at 08:00 h. The optimal PG cut‐off values for predicting treatment success were, respectively, 6, 9, 7 and 6 mmol L −1 at 08:00 h, 11:00, 14:00 and 17:00 h. In most patients the lowest PG values of the diurnal profile were at 17:00 h, and 17·5% of the patients with HbA1c < 7% (54·5% of them treated with sulphonylureas) exhibited a PG value less than 4·4 mmol L −1 at 17:00 h ( P = 0·0034 vs. the other timepoints). Conclusions Glucose monitoring at 17:00 h, i.e. during the extended postlunch period, appears as a global marker of control in noninsulin‐using type 2 diabetic patients both for detecting patients at risk of hypoglycaemia and for assessing the short‐term quality of diabetic control.