title: High incidence of hypoglycemia in stable insulin-treated type 2 diabetes mellitus: continuous glucose monitoring vs. self-monitored blood glucose. Observational prospective study.
abstract: OBJECTIVE
  Hypoglycemia is a limiting factor in the achievement of strict glycemic control. The primary objective of this 9-week study was to determine the frequency of hypoglycemia in patients with stable insulin-treated type 2 diabetes mellitus by comparing self-monitored blood glucose (SMBG) measurement with continuous glucose monitoring (CGM).
  
  
  METHODS
  This was an observational prospective study. Included in the study were 63 stable, insulin-treated patients with type 2 diabetes. They were instructed to record 2 daily capillary blood glucose readings, pre- and/or postprandial, in a sequential way during 8 consecutive weeks. A CGM system was worn during an additional week. We evaluated the frequency of hypoglycemia using the 8-week SMBG profile and the 1 CGM week.
  
  
  RESULTS
  SMBG revealed that 50% of the patients had experienced hypoglycemia. CGM found hypoglycemia in 59% of patients. Significantly higher percentages of hyperglycemic and hypoglycemic episodes were detected by CGM than by capillary blood glucose measurements (61.1% vs. 50.8%; p=0.047) and (3.8% vs. 1.7%; p=0.016); 33% of patients experienced nocturnal hypoglycemia, and 19% of patients who had no data concerning hypoglycemia recorded in the capillary blood glucose diary had experienced hypoglycemia as measured by CGM, and the hypoglycemia occurred mainly during the nocturnal period.
  
  
  CONCLUSIONS
  In stable well-controlled, insulin-treated patients with type 2 diabetes, CGM showed higher numbers of hypoglycemic events than did SMBG, especially at night. CGM is a useful tool that provides clinically valuable information about glucose control in these patients.
authors.affiliation: Hospital Complex Santiago de Compostela, Endocrinology and Nutrition Service, Santiago de Compostela, Spain. Electronic address: marcospazos@gmail.com.
authors.forename: Marcos
authors.initials: M
authors.lastname: Pazos-Couselo
authors.affiliation: Hospital Complex Santiago de Compostela, Endocrinology and Nutrition Service, Santiago de Compostela, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: García-López
authors.affiliation: Hospital Complex Santiago de Compostela, Endocrinology and Nutrition Service, Santiago de Compostela, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: González-Rodríguez
authors.affiliation: Hospital Complex Santiago de Compostela, Clinical Epidemiology Unit, Santiago de Compostela, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gude
authors.affiliation: University of Santiago de Compostela, Gerontology Department, Santiago de Compostela, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Mayán-Santos
authors.affiliation: University of Santiago de Compostela, Biochemistry and Molecular Biology, Santiago de Compostela, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Rodríguez-Segade
authors.affiliation: University of Santiago de Compostela, Biochemistry and Molecular Biology, Santiago de Compostela, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Rodríguez-García
authors.affiliation: Hospital Complex Santiago de Compostela, Endocrinology and Nutrition Service, Santiago de Compostela, Spain; Physiopathology of Obesity and Nutrition Biomedical Research Network Consortium, Santiago de Compostela, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Casanueva
mesh_terms: D000368:Aged; D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: autosurveillance glycémique du diabète de type 2; continuous glucose monitoring; hypoglycemia; hypoglycémie; self-monitored blood glucose; surveillance du glucose en continue; type 2 diabetes