Ambulatory glucose profile in managing hypoglycemia in patients with type 2 diabetes mellitus: a case report
DOI:
https://doi.org/10.18203/2349-3933.ijam20200029Keywords:
Ambulatory glucose profile, Continuous glucose monitoring, HypoglycemiaAbstract
Continuous glucose monitoring (CGM) was done in a 41 years-old female patient with type 2 diabetes mellitus (T2DM) to evaluate the glucose fluctuations, to achieve better glycemic control. The patient presented to the clinic with lethargy, on/off episodes of extreme weakness, sweating, and tingling sensation in the feet (B/L), with leg pains for the past 3 months. She did not have any history of hypertension and cardiovascular disease. On examination, her blood pressure was found to be 120/70 mm Hg. The fasting plasma glucose was 96 mg/dL, postprandial glucose was 160 mg/dL, and glycosylated hemoglobin was 6.8%. The patient was on metformin (500mg)- glimepiride (2mg) combination, once daily, before breakfast, and metformin (500mg) after dinner. Since the symptoms were related to glucose fluctuations and hypoglycemia, the patient was consequently recommended professional CGM to analyze the complete glycemic profile. The profile obtained from Ambulatory Glucose Profile (AGP) revealed glucose fluctuations observed as hypoglycaemia and hyperglycemic episodes. Consequently, the patient’s treatment regimen was changed. The use of glimepiride was discontinued, and the patient was recommended with vildagliptin (50 mg) and metformin combination (1000 mg) bid with meals. This case study indicates that the use of CGM may help in improving our understanding of glycemic patterns and may have a beneficial effect on glycemic control.References
Ishikawa T, Koshizaka M, Maezawa Y, Takemoto M, Tokuyama Y, Saito T, et al. Continuous glucose monitoring reveals hypoglycemia risk in elderly patients with type 2 diabetes mellitus. J Diabetes Investig. 2018 Jan;9(1):69-74.
Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008 Jun;358(24):2545-59.
Lin CH, Sheu WH. Hypoglycaemic episodes and risk of dementia in diabetes mellitus: 7-year follow-up study. J Intern Med. 2013 Jan;273(1):102-10.
Araki A, Iimuro S, Sakurai T, Umegaki H, Iijima K, Nakano H, et al. Non-high-density lipoprotein cholesterol: an important predictor of stroke and diabetes-related mortality in Japanese elderly diabetic patients. Geriatr Gerontol Int. 2012 Apr;12 Suppl 1:18-28.
Stahn A, Pistrosch F, Ganz X, Teige M, Koehler C, Bornstein S, et al. Relationship between hypoglycemic episodes and ventricular arrhythmias in patients with type 2 diabetes and cardiovascular diseases: silent hypoglycemias and silent arrhythmias. Diabetes Care. 2014 Feb;37(2):516-20.
Tandon N, Ali MK, Narayan KM. Pharmacologic prevention of microvascular and macrovascular complications in diabetes mellitus: implications of the results of recent clinical trials in type 2 diabetes. Am J Cardiovasc Drugs. 2012 Feb;12(1):7-22.
Wolpert HA. Use of continuous glucose monitoring in the detection and prevention of hypoglycemia. J Diabetes Sci Technol. 2007 Jan;1(1):146-50.
American Diabetes Association. Diabetes Technology: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019 Jan;42(Suppl 1):S71-S80.
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.
Chawla M, Saboo B, Jha S, Bhandari S, Kumar P, Kesavadev J, et al. Consensus and recommendations on continuous glucose monitoring. J Diabetol. 2019;10(1):4-14.
Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline JP, Rayman G, et al. Flash Glucose-Sensing Technology as a Replacement for Blood Glucose Monitoring for the Management of Insulin-Treated Type 2 Diabetes: a Multicenter, Open-Label Randomized Controlled Trial. Diabetes Ther. 2017 Feb;8(1):55-73.
Simonyi G, Csitári G, Gasparics R, Kollár R, Hegedűs Á, Pál Z, et al. Silent hypoglycaemic episodes among well controlled type 2 diabetic patients treated with sulfonylureas [abstract]. Diabetologia. 2015;58(Suppl 1):S465.
Scherbaum WA, Schweizer A, Mari A, Nilsson PM, Lalanne G, Wang Y, et al. Evidence that vildagliptin attenuates deterioration of glycaemic control during 2-year treatment of patients with type 2 diabetes and mild hyperglycaemia. Diabetes Obes Metab. 2008 Nov;10(11):1114-24.
He YL, Foteinos G, Neelakantham S, Mattapalli D, Kulmatycki K, Forst T, et al. Differential effects of vildagliptin and glimepiride on glucose fluctuations in patients with type 2 diabetes mellitus assessed using continuous glucose monitoring. Diabetes Obes Metab. 2013 Dec;15(12):1111-9.
