High Frequency of Unrecognized Hypoglycaemias in Patients with Type 2 Diabetes is Discovered by Continuous Glucose Monitoring

 

 Buy Article Permissions and Reprints

Abstract

Aims To evaluate the use of a CGMS in the detection of hypoglycaemia in people with type 2 diabetes as an outpatient procedure

Methods 31 type 2 diabetic patients underwent glucose monitoring by means of CGMS (Medtronic MiniMed) for up to three days. Patients took part in at least four SMBG (self monitoring blood glucose) tests per day. After three days, of monitoring the CGMS data was downloaded and analysed by a physician to identify the frequency of hypoglycaemias (≤50 mg/dl) and borderline values (51-70 mg/dl), their duration and distribution. Findings were discussed with the patient and if necessary treatment was adjusted. Eight weeks later, monitoring was repeated to asses the effects of the adjusted treatment.

Results Average duration of sensor wear was 4.19 days. Correlation between the sensor and the SMBG readings was high. A high number of hypoglycaemias and borderline values were detected by the CGMS, most of them unrecognized by the patient. The frequency of hypoglycaemias and borderline values just as the duration could be significantly reduced from first to second monitoring.

Conclusion Using the CGMS in type 2 diabetic patients achieved the detection of numerous hypoglycaemias and borderline values both nocturnal and/or unnoticed. The CGMS provides accurate data, which cannot be achieved by conventional SMBG tests. That opens the possibility for treatment adjustment and improvement in metabolic control. For patients it provides a better understanding of the effects of insulin or oral agents, nutrition and exercises to their glucose level.

References

• 1 Boland E, Monsod T, Delucia M, Brandt CA, Fernando S, Tambolane WV. Limitations of conventional methods of self-monitoring of blood glucose. lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes.  Diabetes Care. 2001;  24 1858-1862
  PubMedGoogle Scholar
• 2 Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB, Monauni T, Muggeo M. Homeostasis Model Assessment closely mirrors the Glucose Clamp technique in the assessment of insulin sensitivity.  Diabetes Care. 2000;  23 57-63
  CrossrefPubMedGoogle Scholar
• 3 Chase HP, Kim LM, Owen SL, MacKenzie TA, Klingersmith GJ, Murtfeld R, Garg SK. Continuous subcutaneous glucose monitoring in children with type 1 diabetes.  Pediatrics. 2001;  107 222-226
  CrossrefPubMedGoogle Scholar
• 4 Cheyne HP, Kerr D. Making sense of Diabetes: Using continuous glucose sensor in clinical practise.  Diab Metab Res Rev. 2002;  18 ((Suppl 1)) 43-48
  CrossrefPubMedGoogle Scholar
• 5 Chico A, Vidal-Ríos P, Subirà M, Novialis A. The Continuous Glucose Monitoring System is useful for detecting unrecognized hypoglycaemias in patients with type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control.  Diabetes Care. 2003;  26 1153-1157
  PubMedGoogle Scholar
• 6 Clarke WL, Cox DJ, Gonder-Frederick, Julian D. Reduced awareness of hypoglycaemia in adults with IDDM.  Diabetes Care. 1995;  18 517-522
  CrossrefPubMedGoogle Scholar
• 7 Gold EA, Mac Leod KM, Frier B. Frequency of severe hypoglycaemia in patients with type 1 diabetes with impaired awareness of hypoglycaemia.  Diabetes Care. 1994;  17 697-703
  CrossrefPubMedGoogle Scholar
• 8 Hay LC, Wilmshurst EG, Fulcher G. Unrecognized hypo- and hyperglycaemia in well-controlled patients with type 2 diabetes mellitus: the results of continuous glucose monitoring.  Diab Technol Ther. 2003;  5 19-26
  CrossrefPubMedGoogle Scholar
• 9 Hirsch IB. Hypoglycaemia and the hypoglycaemic unawareness syndrome.  Diabetes Technol Ther. 2000;  2 ((Suppl 1)) 81-87
  PubMedGoogle Scholar
• 10 MacGowan K, Thomas W, Moran A. Spurious reporting of nocturnal hypoglycaemia by CGMS in patients with tightly controlled type 1 diabetes.  Diabetes Care. 2002;  25 1499-1503
  PubMedGoogle Scholar
• 11 Metzger M, Leibowitz G, Wainstein J, Glazer B, Raz I. Reproducibility of glucose measurements using glucose sensor.  Diabetes Care. 2002;  25 1185-1191
  PubMedGoogle Scholar
• 12 Mostrototaro JJ. The MiniMed Continuous Glucose Monitoring System.  Diabetes Technol Ther. 2000;  2 ((Suppl 1)) 13-17
  CrossrefPubMedGoogle Scholar
• 13 Schiffiani R, Ciampalini P, Fierabracci A, Sepra S, Borelli P, Bottazo GF, Grino A. The Continuous Glucose Monitoring System Relationships with HbA1c in pediatric type 1 diabetic patients.  Diabetes Care. 2002;  25 1840-1844
  PubMedGoogle Scholar
• 14 Tannenberg R, Bode B, Lane W, Levetan C, Mestman J, Harmel AP, Tobian J, Gross T, Mostrototaro J. Use of the Continuous Glucose Monitoring System to guide therapy in patients with insulin-treated diabetes: a randomized controlled trial.  Mayo Clin Proc. 2004;  79 ((12)) 1521-1526
  PubMedGoogle Scholar
• 15 The Diabetes Control Complications Research Group. . The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus.  N Engl J Med. 1993;  329 977-986
  Google Scholar
• 16 UK Prospective Diabetes Study (UKPDS) Group. . Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 Diabetes (UKPDS 33).  Lancet. 1998;  652 837-853
  PubMedGoogle Scholar

Correspondence

Ms. K. K. Weber

Department of Internal Medicine

St. -Johannes-Hospital Dortmund

Johannesstr. 9-17

44137 Dortmund

Germany

Phone: +0231/1843-0

Email: weberkatharina@web.de