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Patterns of Glycemic Variability During a Diabetes Self-Management Educational Program

1
Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal 462020 India
2
Hospital Services, All India Institute of Medical Sciences, Bhopal 462020, India
3
Department of Medicine, All India Institute of Medical Sciences, Bhopal 462020, India
*
Author to whom correspondence should be addressed.
Med. Sci. 2019, 7(3), 52; https://doi.org/10.3390/medsci7030052
Received: 24 January 2019 / Revised: 14 March 2019 / Accepted: 19 March 2019 / Published: 25 March 2019
(This article belongs to the Section Endocrinology and Metabolic Diseases)
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Abstract

Background: Variations in blood glucose levels over a given time interval is termed as glycemic variability (GV). Higher GV is associated with higher diabetes-related complications. The current study was done with the aim of detecting the sensitivity of various GV indices among individuals with type 2 diabetes mellitus of different glycemic control status. Methods: We performed a longitudinal study among individuals with type 2 diabetes mellitus (T2DM) who were participating in a two-week diabetes self-management education (DSME) program. Participants were categorized by their HbA1c as poor (≥8%), acceptable (7%–8%), and optimal control (<7%). Continuous glucose monitoring (CGM) sensors recorded interstitial glucose every 15 min from day 1. The evaluated GV measures include standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), continuous overlapping net glycemic action (CONGA), mean of daily difference for inter-day variation (MODD), high blood glucose index (HBGI), and low blood glucose index (LBGI). Results: A total of 41 study participants with 46347 CGM values were available for analysis. Of 41 participants, 20 (48.7%) were in the poor, 10 (24.3%) in the acceptable, and 11 (26.8%) in the optimal control group. The GV indices (SD; CV; MODD; MAGE; CONGA; HBGI) of poorly controlled (77.43; 38.02; 45.82; 216.63; 14.10; 16.62) were higher than acceptable (50.02; 39.32; 30.79; 138.01; 8.87; 5.56) and optimal (34.15; 29.46; 24.56; 126.15; 8.67; 3.13) control group. Glycemic variability was reduced in the poorly and acceptably controlled groups by the end of the 2-week period. There was a rise in LBGI in the optimally controlled group, indicating pitfalls of tight glycemic control. Conclusion: Indices of glycemic variability are useful complements, and changes in it can be demonstrated within short periods. View Full-Text
Keywords: glycemic variability; MAGE; CONGA; MODD; HBGI; LBGI glycemic variability; MAGE; CONGA; MODD; HBGI; LBGI
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Joshi, A.; Mitra, A.; Anjum, N.; Shrivastava, N.; Khadanga, S.; Pakhare, A.; Joshi, R. Patterns of Glycemic Variability During a Diabetes Self-Management Educational Program. Med. Sci. 2019, 7, 52.

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