Journal Article

Evaluation of glycemic variability in chronic liver disease patients with type 2 diabetes mellitus using continuous glucose monitoring

Inagaki, Yuki, Tsuge, Masataka, Imamura, Michio, Nakahara, Takashi, Ochi, Hidenori, Hyogo, Hideyuki, Aikata, Hiroshi, Hiramatsu, Akira, Kobayashi, Tomoki, Morio, Kei, Chayama, Kazuaki, Nagaoki, Yuko, Teraoka, Yuji, Kawakami, Yoshiiku, Kawaoka, Tomokazu, Honda, Fumi, Daijo, Kana, Yoneda, Masayasu

2018

Overview

The feature of blood glucose dynamics in patients with chronic liver disease (CLD) is marked blood glucose fluctuations. However, the detail of blood glucose dynamics is not well known. The aim of the present study was to evaluate glycemic fluctuations by continuous glucose monitoring (CGM). A total of 105 CLD patients with type 2 diabetes mellitus (T2DM) were enrolled in this study. Various parameters of glycemic variability were evaluated. The association of these parameters with liver functional reserve was examined. The parameters were also evaluated according to glycated hemoglobin A1c (HbA1c) levels. Data of all patients showed that mean blood glucose (MBG) levels and the difference between highest and lowest blood glucose (ΔBG) increased significantly with worsening of liver functional reserve (P < 0.001 and P = 0.005, respectively). Although many of the cases were being treated for diabetes, postprandial hyperglycemia was seen in 92% of patients. Nocturnal hypoglycemia was seen in 22% of patients. In non-anemic patients with HbA1c levels of < 7.0%, the percentage of patients with mean amplitude of glycemic excursion (MAGE) of ≥ 77.4 mg/dL and that of MBG levels of > 145 mg/dL were higher in liver cirrhosis (LC) patients than in chronic hepatitis (CH) patients. In them, homeostasis model assessment for insulin resistance (HOMA-IR) of > 2.5 and LC were significantly associated with the increase in MAGE. LC was also significantly associated with increased MBG levels. The CGM systems were useful in finding hidden abnormalities of blood glucose fluctuations in CLD patients with T2DM, especially in non-anemic CLD patients with HbA1c levels of < 7.0%.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Abnormalities / Biology and Life Sciences / Blood / Blood glucose / Care and treatment / Cirrhosis / Comorbidity / Complications and side effects / Control / Diabetes / Diabetes mellitus / Diabetes mellitus (non-insulin dependent) / Fluctuations / Gastroenterology / Glucose / Glucose monitoring / Glucose monitors / Health aspects / Health sciences / Hemoglobin / Hepatitis / Hepatology / Homeostasis / Hyperglycemia / Hypoglycemia / Insulin / Insulin resistance / Life sciences / Liver / Liver cirrhosis / Liver diseases / Medicine and Health Sciences / Metabolism / Monitoring / Parameters / Patients / Physical Sciences / Prognosis / Research and Analysis Methods / Risk factors / Type 2 diabetes / Variability