The impact of insulin initiation on glycaemic variability and glucose profile in a type 2 diabetes primary health care cohort – Analysis of continuous glucose monitoring data from the INITIATION Study. — ASN Events
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The impact of insulin initiation on glycaemic variability and glucose profile in a type 2 diabetes primary health care cohort – Analysis of continuous glucose monitoring data from the INITIATION Study. (#264)

Jo-Anne Manski-Nankervis 1 , Irene Blackberry 1 2 , Christopher Yates 3 4 , John Furler , Louise Ginnivan 1 , Neale Cohen 5 , Alicia Jenkins 6 , Sheran Vasanthakumar 7 , Alexandra Gorelik 8 , Doris Young 1 , James Best 9 , David O'Neal 3 10
  1. Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
  2. La Trobe University, Wodonga, Victoria, Australia
  3. University of Melbourne, Carlton, Vic , Australia
  4. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  5. Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
  6. NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
  7. Monash Medical School, Monash University, Melbourne, Victoria, Australia
  8. Melbourne EpiCentre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Vic, Australia
  9. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  10. Department of Medicine, St Vincent's Hospital, Melbourne, Vic, Australia

Aim: Use continuous glucose monitoring (CGM) to examine effects of insulin initiation with glargine+/-glulisine on glycaemic variability (GV) and glycaemia in a primary health-care cohort with type 2 diabetes receiving maximal oral hypoglycaemic agents (OHAs).

Methods: Post-hoc analysis of CGM data from 89 participants at baseline and 24-weeks post-insulin commencement participating in the INITIATION study1. Indicators of GV [standard deviation (SD), J-index and mean amplitude of glycaemic excursion (MAGE)] and glycaemia [HbA1c, mean glucose, area under glucose-time curve (AUC)] were assessed. Multi-level regression analysis was used to identify predictors of change.

Results: Complete GV data were available for 78 participants; 41% female, mean (SD) age 59.2 (10.4) years; median (IQR) diabetes duration 10.4 (6.5, 13.3) years; baseline HbA1c 9.7 (8.7, 11.0) % [82.5 (71.6, 96.7) mmol/mol]. At baseline, BMI negatively correlated with SD (r=-0.30) and MAGE (r=-0.26), but not J-index; HbA1c correlated with J-index (r= 0.61) but not MAGE and SD. Post-insulin initiation mean (SD) glucose decreased [12.0 (3.0) to 8.5 (1.6) mmol/L (p<0.001)], as did J-Index [median (IQR) from 66.9 (47.7, 95.1) to 36.9 (27.6, 49.8) mmol/L] (p<0.001). Baseline HbA1c correlated with a greater J-index reduction (r=-0.45; p<0.001). MAGE and SD were unchanged. The baseline temporal profile, revealing elevated post-prandial morning glucose levels, was largely unchanged post-insulin initiation, despite an overall reduction in glycaemia (see Figure).

Conclusion: Insulin initiation reduced hyperglycaemia but did not alter GV in adults with type 2 diabetes receiving maximal OHAs. The most significant postprandial excursions were seen in the morning, identifying pre-breakfast as the most effective target for short-acting insulin therapy. 

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  1. Blackberry, I., et al., An exploratory trial of basal and prandial insulin initiation and titration for type 2 diabetes in primary care with an adjunct retrospective continuous glucose monitoring: INITIATION STUDY Diabetes Research and Clinical Practice, 2014. 106(2): p. 247-255.