DOI: http://dx.doi.org/10.18203/2349-3933.ijam20200028

Ambulatory glucose profile in managing post-prandial hyperglycaemia in patients with type 2 diabetes mellitus: a case report

Banshi Saboo

Abstract


The case report describes the potential role of real-time Ambulatory Glucose Profile (AGP) in identifying and managing a patient with hyperglycemia. This 55-years-old male patient with type 2 Diabetes Mellitus (T2DM) was presented to the clinic with weakness, increased urinary frequency, with constipation for the past 3 months. The patient was a known case of T2DM for 10 years, along with dyslipidemia, hypertension, and obesity. The profile obtained from AGP revealed glucose fluctuations with post-prandial excursions. Consequently, the patient’s treatment regimen was changed. The use of glimepiride was discontinued, and the patient was recommended with voglibose 0.2 mg bid with two meals, metformin 100 mg + dapagliflozin 10 mg combination with morning meals, and metformin 1000 mg with evening meals. The treatment for hypertension and dyslipidemia was continued. This case study indicates that CGM can help improve our understanding of glycemic patterns and can have a beneficial effect on glycemic control.


Keywords


Ambulatory glucose profile, Continuous glucose monitoring, Postprandial hyperglycemia, Type 2 diabetes mellitus

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References


Kaiser AB, Zhang N, Der Pluijm WV. Global Prevalence of Type 2 Diabetes over the Next Ten Years (2018-2028). Diabetes. 2018;67(1):202.

Aynalem SB, Zeleke AJ. Prevalence of diabetes mellitus and its risk factors among individuals aged 15 years and above in Mizan-Aman town, Southwest Ethiopia, 2016: a cross sectional study. Inter J Endocrinol. 2018; 9317987.

Nathan DM. for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study research group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643-53.

Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA1c. Diabetes care. 2003 Mar 1;26(3):881-5.

Woerle HJ, Pimenta WP, Meyer C, Gosmanov NR, Szoke E, Szombathy T, et al. Diagnostic and therapeutic implications of relationships between fasting, 2-hour postchallenge plasma glucose and hemoglobin a1c values. Archiv Inter Med. 2004 Aug 9;164(15):1627-32.

Ceriello A, Esposito K, Piconi L, Ihnat MA, Thorpe JE, Testa R, et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes. 2008 May 1;57(5):1349-54.

Zang L, Shimada Y, Nakayama H, Chen W, Okamoto A, Koide H, et al. Therapeutic silencing of centromere protein X ameliorates hyperglycemia in zebrafish and mouse models of type 2 diabetes mellitus. Fron Genet. 2019;10:693.

Pfeiffer KM, Sandberg A, Nikolajsen A, Brod M. Postprandial glucose and healthcare resource use: a cross-sectional survey of adults with diabetes treated with basal-bolus insulin. J Med Econom. 2018 Jan 2;21(1):66-73.

Burge MR, Mitchell S, Sawyer A, Schade DS. Continuous glucose monitoring: the future of diabetes management. Diabe Spectrum. 2008 Apr 1;21(2):112-9.

Evans M, Cranston I, Bailey CJ. Ambulatory glucose profile (AGP): utility in UK clinical practice. Bri J Diabe. 2017 Mar 21;17(1):26-33.

Ceriello A. The possible role of postprandial hyperglycaemia in the pathogenesis of diabetic complications. Diabetologia. 2003 Mar 1;46(1):M9-16.

Cavalot F, Petrelli A, Traversa M, Bonomo K, Fiora E, Conti M, et al. Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J Clin Endocrinol Metab. 2006 Mar 1;91(3):813-9.

Standl E, Schnell O, Ceriello A. Postprandial hyperglycemia and glycemic variability: should we care?. Diabe Care. 2011 May 1;34(2):S120-7.

Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus Statement By The American Association Of Clinical Endocrinologists And American College Of Endocrinology On The Comprehensive Type 2 Diabetes Management Algorithm - 2019 Executive Summary. Endocr Pract. 2019 Jan;25(1):69-100.

Lin SD, Wang JS, Hsu SR, Sheu WH, Tu ST, Lee IT, et al. The beneficial effect of α-glucosidase inhibitor on glucose variability compared with sulfonylurea in Taiwanese type 2 diabetic patients inadequately controlled with metformin: preliminary data. J Diabe Compl. 2011 Sep 1;25(5):332-8.

Wang JS, Lin SD, Lee WJ, Su SL, Lee IT, Tu ST, et al. Effects of acarbose versus glibenclamide on glycemic excursion and oxidative stress in type 2 diabetic patients inadequately controlled by metformin: a 24-week, randomized, open-label, parallel-group comparison. Clin Therap. 2011 Dec 1;33(12):1932-42.

Seo C, Sakamoto M, Nishimura R, Tsujino D, Ando K, Morimoto A, et al. Comparison of glycemic variability in patients with type 2 diabetes given sitagliptin or voglibose: a continuous glucose monitoring–based pilot study. Diabe Technol Therap. 2013 May 1;15(5):378-85.

Joshi P, Mishra S, Singh A. Improvement in blood glucose fluctuations in type 2 diabetes mellitus by voglibose with or without high fiber dietary intervention. Sch J App Med Sci. 2017;5(9C):3676-9.

American Diabetes Association. 7. Diabetes Technology: Standards of Medical Care in Diabetes-2019. Diabe Care. 2019 Jan 1;42(1):S71-80.

Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2019 Aug 31:1-69.