Endocrine Abstracts

The goal of this research was to analyze fasting glycemic variability in patients with DM1 depending on the type of basal insulin therapy - insulin NPH versus Glargine.

Material and methods: The glucose levels 24-hour monitoring was performed applying the CGMS. Glargine group - 19 and NPH group - 24 patients.

Results: In the glargine group there have been no episodes of severe fasting hypoglycemia (<2.8 mmol/L), LBGI=2.42±1.26; in the NPH group the relative duration of period of severe nocturnal hypoglycemia was 15.41±23.12%, LBGI=9.18±8.21. Intra-day variability indices: SD - 1.98±1.01 and 2.71±1.39 mmol\l; VC −24.32±15.49 and 31.51±16.21%; IQR −3.21±1.74 and 5.16±2.75 mmol\l; amplitude of glycemic excursions -7.31±3.42 and 11.24±5.58 mmol\l, CONGA1 - 1.60±0.72 and 2.71±1.62 mmol/l×h-1, P<0.05; for the glargine and NPH groups respectively. The predictors of high fasting glucose variability are frequent short-time (<1h) severe hypoglycemic episodes.

Both groups revealed a strong positive correlation between MODDf (analogous to MODD, but calculated for fasting period only) and difference of mean fasting blood glucose values: in the glargine group - rs=0.78; in the NPH - rs=0.895; P<0.001. Glargine group - MODDf=2.30±1.12; NPH group - MODDf=5.01±2.62, P<0.001.

In the NPH group only, high inter-day variability of blood glucose levels at 3 AM is a reliable predictor of high values of the difference of mean fasting blood glucose values (B=0.662; P<0.001). According to the equation of the linear regression with an increase of the difference of blood glucose values at 3 AM on 1 mmol/L, the difference of mean fasting blood glucose values increases by 0.662 mmol/L. In the Glargine group day-to-day blood glucose values at the control points - 3, 5 and 7 AM - were much more stable.

Conclusion: The use of glargine leads to a significant reduction in daily variability of fasting glycemia, minimizes the risk of hypoglycemia and provides a greater reserve in dosage increase in comparison with NPH insulin.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.