title: Impact of insulin initiation on glycaemic variability and glucose profiles in a primary healthcare Type 2 diabetes cohort: analysis of continuous glucose monitoring data from the INITIATION study.
abstract: To use continuous glucose monitoring to examine the effects of insulin initiation with glargine, with or without glulisine, on glycaemic variability and glycaemia in a cohort of people with Type 2 diabetes receiving maximum oral hypoglycaemic agents in primary healthcare.
  
  
  
  We conducted a post hoc analysis of continuous glucose monitoring data from 89 participants at baseline and at 24 weeks after insulin commencement. Indicators of glycaemic variability (standard deviation, J-index and mean amplitude of glycaemic excursion) and glycaemia (HbA1c , mean glucose, area under the glucose-time curve) were assessed. Multi-level regression analysis was used to identify the predictors of change.
  
  
  
  Complete glycaemic variability data were available for 78 participants. Of these participants, 41% were women, their mean (sd) age was 59.2 (10.4) years, the median (interquartile range) diabetes duration was 10.4 (6.5, 13.3) years and the median (interquartile range) baseline HbA1c was 82.5 (71.6, 96.7) mmol/mol [9.7 (8.7, 11.0)%]. At baseline, BMI correlated negatively with standard deviation (r = -0.30) and mean amplitude of glycaemic excursion (r = -0.26), but not with J-index; HbA1c correlated with J-index (r = 0.61) but not with mean amplitude of glycaemic excursion and standard deviation. After insulin initiation the mean (sd) glucose level decreased [from 12.0 (3.0) to 8.5 (1.6) mmol/l; P < 0.001], as did the median (interquartile range) J-index [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). The mean amplitude of glycaemic excursion and standard deviation values were unchanged. The baseline temporal profile, showing elevated postprandial morning glucose levels, was unchanged after insulin initiation, despite an overall reduction in glycaemia.
  
  
  
  Insulin initiation reduced hyperglycaemia but did not alter glycaemic variability in adults with Type 2 diabetes receiving maximum oral hypoglycaemic agents. The most significant postprandial excursions were seen in the morning, which identifies prebreakfast as the most effective target for short-acting insulin therapy.
authors.affiliation: Department of General Practice, University of Melbourne, Carlton, Vic., Australia.
authors.forename: J
authors.identifier: 0000-0003-2153-3482
authors.initials: J
authors.lastname: Manski-Nankervis
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Vic., Australia.|Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Vic., Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: Yates
authors.affiliation: Department of General Practice, University of Melbourne, Carlton, Vic., Australia.|La Trobe University, Wodonga, Vic., Australia.
authors.forename: I
authors.initials: I
authors.lastname: Blackberry
authors.affiliation: Department of General Practice, University of Melbourne, Carlton, Vic., Australia.
authors.forename: J
authors.initials: J
authors.lastname: Furler
authors.affiliation: Department of General Practice, University of Melbourne, Carlton, Vic., Australia.
authors.forename: L
authors.initials: L
authors.lastname: Ginnivan
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia.
authors.forename: N
authors.initials: N
authors.lastname: Cohen
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Jenkins
authors.affiliation: Monash Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic., Australia.
authors.forename: S
authors.initials: S
authors.lastname: Vasanthakumar
authors.affiliation: Melbourne EpiCentre, Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia.
authors.forename: A
authors.initials: A
authors.lastname: Gorelik
authors.affiliation: Department of General Practice, University of Melbourne, Carlton, Vic., Australia.
authors.forename: D
authors.initials: D
authors.lastname: Young
authors.affiliation: Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Best
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Vic., Australia.
authors.forename: D
authors.initials: D
authors.lastname: O'Neal
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000379:methods; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000069036:Insulin Glargine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069036:Insulin Glargine; C479079:insulin glulisine