title: Glycemic variability during algorithmic titration of insulin among hospitalized patients with type 2 diabetes and heart failure.
abstract: OBJECTIVE
  The objective of this study is to assess hypoglycemia and glycemic variability (GV) in hospitalized patients with and without heart failure (HF) exacerbation.
  
  
  METHODS
  Hospitalized patients with type 2 diabetes (T2D) with (N=35) or without (N=16) HF who had hyperglycemia or significant insulin use were included. Subjects underwent continuous glucose monitoring during algorithmic titration of basal bolus insulin.
  
  
  RESULTS
  HF subjects had lower glucose coefficient of variation ([CV], 31±12 vs. 22±8.2, p=0.02), lower Low Blood Glucose Index (LBGI) and less hypoglycemia (25% vs. 2.6%, p=0.02), but similar mean glucose and glycemic lability index as non-HF subjects on day 1, but not on day 2. Sensor CV was correlated with hypoglycemia (ρ 0.32, p=0.02), HF status (ρ -0.35, p=0.013), T2D duration (ρ 0.29, p=0.04), insulin use prior to admission (ρ 0.42, p=0.002) and catecholamine levels. After controlling for differences in age, HbA1c, hypoglycemia, catecholamine levels, QT interval, and beta blocker use, only HF and diabetes duration or insulin use prior to admission were independent predictors of CV. HF had less robust associations with LBGI in multivariable models.
  
  
  CONCLUSIONS
  HF is not associated with increased GV or hypoglycemia risk during initial titration of insulin. Further research is needed to determine prognostic implications.
authors.affiliation: The Ohio State University Division of Endocrinology, Diabetes & Metabolism, 1581 Dodd Drive, Columbus, OH 43210. Electronic address: Kathleen.dungan@osumc.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dungan
authors.affiliation: The Ohio State University Dorothy M. Davis Heart and Lung Research Institute, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210; The Ohio State University Division of Cardiovascular Medicine, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210.
authors.forename: Philip
authors.initials: P
authors.lastname: Binkley
authors.affiliation: The Ohio State University Division of Endocrinology, Diabetes & Metabolism, 1581 Dodd Drive, Columbus, OH 43210.
authors.forename: Kwame
authors.initials: K
authors.lastname: Osei
mesh_terms: D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D058065:Diabetic Cardiomyopathies / Q000503:physiopathology*; D016903:Drug Monitoring; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006786:Hospitals, Urban; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009820:Ohio / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Glycemic variability; Heart failure; Hospital; Hypoglycemia; Insulin