COMPARISON OF GLYCEMIC VARIABILITY IN DM1 PATIENTS WITH CHART BASAL-BOLUS USING HUMAN INSULINS OR ANALOGS

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 786-805-Diabetes & Obesity Therapeutics
Bench to Bedside
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-791
Flavia Guimaraes Mercon*1, Joao Eduardo Salles2, Nilza Maria Scalissi3, Daniela F N Sepulcre4 and Eduardo P G Vieira4
1Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil, 2Santa Casa Medical School, 000 Sao Paulo, Brazil, 3Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil, 4Irmandade da Santa Casa de Misericordia de Sao Paulo
BACKGROUND: Adequate control of blood glucose is related to decrease chronic complications in patients with DM1, evidenced by hemoglobin A1c (HbA1c) below 7%, fewer hypos and lower glycemic variability.

OBJECTIVE: To compare patients with DM1 in use of human insulin and insulin analogs as the mean blood glucose levels, HbA1c, risk of hypoglycemia (via LBGI-Low Blood Glucose Index) and hyperglycemia (via HBGI-Hight Blood Glucose Index) and variability glucose (via SD).

PATIENTS AND METHODS: We evaluated 24 patients with type 1 diabetes between 2010 and 2011, instructed to perform six measures of blood glucose daily for a period of three weeks. The mean blood glucose values, SD,LBGI and HBGI were calculated by the data manager Accu-Chek® 360º Roche. Personal and HbA1C were collected from medical records. We used the Mann-Whitney test to compare the data.

RESULTS: The patients were divided into two groups: basal insulin NPH (n = 9, mean age: 29.78 years) x basal insulin analogs (n = 15 - Detemir: 2 and Glargine: 13, mean age: 33.27 years).

DISCUSSION: The NPH group achieved a mean HbA1c and mean blood glucose greater than the Analogs group, but without statistical significance, which may mean that obtaining these parameters independent of insulin regimen chosen. Moreover the values of SD indicate favorably to the group Analogs to indicate a lower glycemic variability. The most recent data show that glycemic variability may imply a significant risk of complications. A comparison of HBGI showed increased risk of hyperglycemia group using NPH. The LBGI was lower in Analogs, but are not able to show superiority of any treatment on the risk of hypoglycemia.

CONCLUSION: The data analysis suggests that patients with DM1 treated with basal insulin analogs may have a reduced glycemic variability and therefore less risk of macrovascular and microvascular chronic complications compared with those on basal insulin NPH.

1. The Diabetes Control and Complications Trial 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; 2. IRL B. Hirsch, M.D. Glycemic Variability: It’s Not Just About A1C Anymore! Diabetes Technology & Therapeutics, 2005, vol. 07, no 5, 780-783; 3. Risso A, Mercuri F, Quagliaro L, Damante G, Ceriello A: Intermittent high glucose enhances apoptosis in human umbilical vein endothelial cells in culture. Am J Physiol Endocrinol Metab 2001; 281:E924–E930; 4. Kovatchev BP, Cox DJ, Frederick LAG, Hyman DY, Schlundt D, Clarke W: Assesment of Risck for Severe Hypoglicemia Among Adults with IDDM. Diabetes Care, 1998, vol 21, no 11, 1870-1875

Nothing to Disclose: FGM, JES, NMS, DFNS, EPGV

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