title: Glucose variability indices predict the episodes of nocturnal hypoglycemia in elderly type 2 diabetic patients treated with insulin.
abstract: OBJECTIVE
  O determine the applicability of glucose variability (GV) indices derived from continuous glucose monitoring (CGM) data for prediction of nocturnal hypoglycemia (NH) in elderly patients with type 2 diabetes treated with insulin.
  
  
  METHODS
  We observed 83 insulin-treated in-patients, 65-80 years of age. Blinded CGM data for 176 nights were analyzed. Daytime (06:00-22:59) mean glucose, Standard Deviation (SD), 2-h Continuous Overlapping Net Glycemic Action (CONGA2) and Mean Absolute Glucose (MAG), pre-midnight (23:00-23:59) mean glucose, SD and MAG, 24-h Mean Amplitude of Glucose Excursions (MAGE), were estimated. Pre-midnight glucose trends were estimated as the absolute difference between glucose values at 23:00 and 23:59 (deltaG). Episode of interstitial glucose ≤70mg/dL observed from 0:00 to 5:59 was considered as NH.
  
  
  RESULTS
  NH was present in 68 out of 176 24-h recordings (39%). Lower daytime mean glucose and CONGA2, and higher MAG values were found in patients with NH as compared to those without (p=0.0002, p=0.0001 and p=0.02, respectively). Pre-midnight mean glucose was lower, while pre-midnight deltaG was higher in patients with NH (p<0.0001 and p=0.02). Antecedent daytime hypoglycemia increased the risk of NH (p<0.0001). In logistic regression analysis, the combination of daytime MAG and pre-midnight mean glucose was the most reliable predictor of subsequent NH (accuracy 75.6%, p=0.0004).
  
  
  CONCLUSIONS
  The analysis of CGM-derived GV parameters could improve prediction of NH in elderly patients with type 2 diabetes treated with insulin.
authors: Professor, Laboratory of Endocrinology, Scientific Institute of Clinical and Experimental Lymphology, Timakov Str. 2, Novosibirsk 630060, Russian Federation. Electronic address: klimontov@mail.ru.
authors: Vadim V
authors: VV
authors: Klimontov
authors: MD, Laboratory of Endocrinology, Scientific Institute of Clinical and Experimental Lymphology, Novosibirsk, Russian Federation.
authors: Natalia E
authors: NE
authors: Myakina
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects*; D008297:Male; D008991:Monitoring, Physiologic; D018570:Risk Assessment
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Continuous glucose monitoring; Glucose variability; Hypoglycemia; Type 2 diabetes