title: Four-Point Preprandial Self-Monitoring of Blood Glucose for the Assessment of Glycemic Control and Variability in Patients with Type 2 Diabetes Treated with Insulin and Vildagliptin.
abstract: The study explored the utility of four-point preprandial glucose self-monitoring to calculate several indices of glycemic control and variability in a study adding the DPP-4 inhibitor vildagliptin to ongoing insulin therapy. This analysis utilized data from a double-blind, randomized, placebo-controlled crossover study in 29 patients with type 2 diabetes treated with vildagliptin or placebo on top of stable insulin dose. During two 4-week treatment periods, self-monitoring of plasma glucose was undertaken at 4 occasions every day. Glucose values were used to assess several indices of glycemic control quality, such as glucose mean, GRADE, M-VALUE, hypoglycemia and hyperglycemia index, and indices of glycemic variability, such as standard deviation, CONGA, J-INDEX, and MAGE. We found that vildagliptin improved the glycemic condition compared to placebo: mean glycemic levels, and both GRADE and M-VALUE, were reduced by vildagliptin (P < 0.01). Indices also showed that vildagliptin reduced glycemia without increasing the risk for hypoglycemia. Almost all indices of glycemic variability showed an improvement of the glycemic condition with vildagliptin (P < 0.02), though more marked differences were shown by the more complex indices. In conclusion, the study shows that four-sample preprandial glucose self-monitoring is sufficient to yield information on the vildagliptin effects on glycemic control and variability.
authors.affiliation: CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127 Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tura
authors.affiliation: Department of Clinical Sciences, Lund University, B11 BMC, 22184 Lund, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Farngren
authors.affiliation: Novartis Pharma AG, 4002 Basel, Switzerland.
authors.forename: Anja
authors.initials: A
authors.lastname: Schweizer
authors.affiliation: Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Foley
authors.affiliation: CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127 Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pacini
authors.affiliation: Department of Clinical Sciences, Lund University, B11 BMC, 22184 Lund, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Ahrén