Elaine Chow, Hong Kong PRC
The Chinese University of Hong Kong Medicine and TherapeuticsPresenter of 2 Presentations
DIFFERENCE BETWEEN SENSOR-DERIVED GLUCOSE MANAGEMENT INDICATOR (GMI) AND LABORATORY HBA1C IN PATIENTS WITH TYPE 2 DIABETES
Abstract
Background and Aims
Glucose management indicator (GMI) is an updated approach for estimating HbA1c from continuous glucose monitoring (CGM) data. GMI has been validated in patients with type 1 diabetes, however data in type 2 diabetes (T2D) is lacking.
Methods
112 paired laboratory A1c and GMI values were collected from 50 T2D patients on insulin and oral antidiabetic drugs. Patients had professional CGM (Medtronic Ipro2 with Enlite® sensor) for seven days with laboratory HbA1c determined in the same week. The agreement between laboratory HbA1c and sensor-derived GMI was examined using Bland-Altman plot with repeated subject measures.
Results
24% of GMI values were within 0.25% of laboratory HbA1c and 40% of GMI values were within 0.5% from laboratory HbA1c values. Overall, GMI was lower than laboratory HbA1c (mean bias -0.8%, 95% limits of agreement -2.4 to 0.9%).The bias was greater at higher laboratory HbA1c values (see Fig).
Fig Bland-Altman plot of difference between Glucose Management index (GMI) minus laboratory HbA1c versus laboratory HbA1c in type 2 diabetes patient.
Conclusions
There are differences between sensor-derived GMI and laboratory HbA1c based on retrospective CGM in T2D patients, with GMI tending to be lower. This could be attributed to factors such as CGM duration, sensor accuracy, differences in glycation, acute change in glucose or patient behaviours on CGM. Clinicians should consider these factors when integrating both sets of values in therapeutic decision making.
GLYCAEMIC VARIABILITY AND TIME-IN-RANGE DURING SELF-TITRATION OF ONCE DAILY INSULIN GLARGINE 300U/ML VERSUS NPH (NEUTRAL PROTAMINE HAGEDORN) INSULIN IN INSULIN-NAÏVE CHINESE TYPE 2 DIABETES PATIENTS
Abstract
Background and Aims
Insulin glargine 300U/ml (Gla-300) is a second-generation basal insulin analogue that is associated with lower risk of hypoglycaemia and glycaemic variability (GV). We compared GV and time-in-range (TIR) in Chinese T2D patients initiated on once daily bedtime Gla-300 versus NPH.
Methods
This was a 24-week, 1:1 randomized, open-label study, comparing patient-adjusted titration of Gla-300 versus NPH at bedtime in 50 insulin-naïve T2D patients on maximal oral antidiabetic drugs. The starting dose was 0.2U/kg/day and with self-titration of 1 unit per week to achieve a target fasting glucose of 4.4 to 6 mmol/l, without hypoglycaemia. Patients had seven-day professional continuous glucose monitoring (CGM) (Medtronic iPro®2 with Enlite sensor) at baseline, week 12 and 24. The nocturnal period was defined as 00:00 to 06:00 hours.
Results
Percentage TIR between 3.9 to 10mmol/l was similar in NPH and Gla-300 groups at baseline (Mean ±SD 48±16 versus 47±22 %). At 24 weeks, overall TIR was similar between NPH and Gla-300 groups (61±16 versus 60±17%) with no difference in GV. During the nocturnal period, % time below 3.9mmol/l was significantly lower in the Gla-300 group (p =0.04, Fig 1). Nocturnal GV as expressed by the coefficient of variation was significantly lower in Gla-300 verus NPH groups (25±6% versus 34±9% , p = 0.008). There were no differences between groups in TIR or GV during daytime hours.
Conclusions
Once daily bedtime Gla-300 was associated with lower nocturnal GV and CGM-detected hypoglycaemia as compared with NPH insulin.
Funding: Sanofi investigator-initiated study