PMID- 35498416 OWN - NLM STAT- MEDLINE DCOM- 20220503 LR - 20221207 IS - 1664-2392 (Print) IS - 1664-2392 (Electronic) IS - 1664-2392 (Linking) VI - 13 DP - 2022 TI - Largest Amplitude of Glycemic Excursion Calculating from Self-Monitoring Blood Glucose Predicted the Episodes of Nocturnal Asymptomatic Hypoglycemia Detecting by Continuous Glucose Monitoring in Outpatients with Type 2 Diabetes. PG - 858912 LID - 10.3389/fendo.2022.858912 [doi] LID - 858912 AB - AIMS: Nocturnal asymptomatic hypoglycemia (NAH) is a serious complication of diabetes, but it is difficult to be detected clinically. This study was conducted to determine the largest amplitude of glycemic excursion (LAGE) to predict the episodes of NAH in outpatients with type 2 diabetes. METHODS: Data were obtained from 313 outpatients with type 2 diabetes. All subjects received continuous glucose monitoring (CGM) for consecutive 72 hours. The episodes of NAH and glycemic variability indices (glucose standard deviation [SD], mean amplitude of plasma glucose excursion [MAGE], mean blood glucose [MBG]) were accessed via CGM. LAGE was calculated from self-monitoring blood glucose (SMBG). RESULTS: A total of 76 people (24.3%) had NAH. Compared to patients without NAH, patients with NAH showed higher levels of glucose SD (2.4 +/- 0.9 mmol/L vs 1.7 +/- 0.9 mmol/L, p <0.001), MAGE (5.2 +/- 2.1 mmol/L vs 3.7 +/- 2.0, p<0.001) and LAGE (4.6 +/- 2.3 mmol/L vs 3.8 +/- 1.9 mmol/L, p=0.007), and lower level of MBG (7.5 +/- 1.5 mmol/L vs 8.4 +/- 2.2 mmol/L, p=0.002). LAGE was significantly associated with the incidence of NAH and time below rang (TBR) in model 1 [NAH: 1.189 (1.027-1.378), p=0.021; TBR: 0.008 (0.002-0.014), p=0.013] with adjustment for age, BMI, sex, work, hyperlipidemia, complication and medication, and in model 2 [NAH: 1.177 (1.013-1.367), p=0.033; TBR: 0.008 (0.002-0.014), p=0.012] after adjusting for diabetes duration based on model 1, as well as in model 3 [NAH: 1.244 (1.057-1.464), p=0.009; TBR: 0.009 (0.002-0.016), p=0.007] with further adjustment for HbA1c based on model 2. In addition, no significant interactions were found between LAGE and sex, age, HbA1c, duration of diabetes, BMI and insulin therapy on the risk of NAH. The receiver operator characteristic (ROC) curve shows the ideal cutoff value of LAGE for the prediction of NAH was 3.48 mmol/L with 66.7% sensitivity, 50% specificity and 0.587 (95% CI: 0.509-0.665) of area under the ROC curve. CONCLUSIONS: High glycemic variability is strongly associated with the risk of NAH. The LAGE based on SMBG could be an independent predictor of NAH for outpatients with type 2 diabetes, and LAGE greater than 3.48 mmol/L could act as a warning alarm for high risk of NAH in daily life. CI - Copyright (c) 2022 Wang, Tan, Wu, Shen, Huang, Wang, Liu, Song, Lin, Shi and Li. FAU - Wang, Shoubi AU - Wang S AD - Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. AD - Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. FAU - Tan, Zhenhua AU - Tan Z AD - Xiahe Branch of the Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China. FAU - Wu, Ting AU - Wu T AD - The School of Clinical of Medicine, Fujian Medical University, Fuzhou, China. FAU - Shen, Qingbao AU - Shen Q AD - Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. FAU - Huang, Peiying AU - Huang P AD - Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. FAU - Wang, Liying AU - Wang L AD - Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. FAU - Liu, Wei AU - Liu W AD - Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. FAU - Song, Haiqu AU - Song H AD - Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. FAU - Lin, Mingzhu AU - Lin M AD - Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. FAU - Shi, Xiulin AU - Shi X AD - Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. FAU - Li, Xuejun AU - Li X AD - Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. LA - eng PT - Journal Article DEP - 20220414 PL - Switzerland TA - Front Endocrinol (Lausanne) JT - Frontiers in endocrinology JID - 101555782 RN - 0 (Blood Glucose) RN - 0 (Glycated Hemoglobin A) SB - IM MH - Blood Glucose MH - Blood Glucose Self-Monitoring MH - *Diabetes Mellitus, Type 2/complications/diagnosis MH - Glycated Hemoglobin MH - Humans MH - *Hypoglycemia/diagnosis/etiology MH - Outpatients PMC - PMC9047895 OTO - NOTNLM OT - continuous glucose monitoring OT - largest amplitude of glycemic excursion OT - nocturnal asymptomatic hypoglycemia OT - outpatients with type 2 diabetes OT - self-monitoring blood glucose COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2022/05/03 06:00 MHDA- 2022/05/04 06:00 PMCR- 2022/01/01 CRDT- 2022/05/02 07:11 PHST- 2022/01/20 00:00 [received] PHST- 2022/03/15 00:00 [accepted] PHST- 2022/05/02 07:11 [entrez] PHST- 2022/05/03 06:00 [pubmed] PHST- 2022/05/04 06:00 [medline] PHST- 2022/01/01 00:00 [pmc-release] AID - 10.3389/fendo.2022.858912 [doi] PST - epublish SO - Front Endocrinol (Lausanne). 2022 Apr 14;13:858912. doi: 10.3389/fendo.2022.858912. eCollection 2022.