Time in ranges and glucose variability in patients with type 2 diabetes on different regimens of insulin therapy

Insulin is used in the treatment of a significant proportion of patients with type 2 diabetes (T2D), while many patients do not achieve glycemic control targets. Aim of the study was to assess the achievability of target parameters of time in ranges and glucose variability (GV) in hospitalized patients with T2D during insulin therapy adjustment under the control of continuous glucose monitoring (CGM) and to determine factors influencing these parameters.

Material and methods. A retrospective comparative single-center study was conducted in real world settings. Patients were divided into 3 groups: 1) basal insulin (BI) therapy; 2) pre-mixed insulin (PMI) therapy; 3) basal-bolus insulin therapy (BBIT) in the mode of multiple daily injections. Time in the target range (TIR), time in the range above and below the target (TAR L-1, TAR L-2, TBR-L1, TBR L-2), coefficient of variability (CV), mean amplitude of glucose excursions (MAGE), lability index (LI), and mean absolute glucose rate of change (MAG) were derived from CGM recordings.

Results. The study recruited 371 patients (167 were on BI, 40 on PMI, and 164 on BBIT). The mean glucose level, TIR, TBR, and TAR L-1 did not differ between three groups. TAR L-2 values and GV indices (CV, MAGE, LI) were higher in patients on BBIT than in those on BI. Patients on PMI did not show significant differences from other groups. In multivariate regression analysis, C-peptide level turned out to be an independent predictor of CV, MAGE, and LI; body mass index was associated with MAG and LI.

Conclusions. Correction of insulin therapy under the CGM control allows achieving target glucose values in most patients with T2D. Patients on BBIT have higher GV than those on BI at similar TIR. The GV parameters in patients with T2D on insulin therapy are inversely associated with endogenous insulin secretion (C-peptide level).

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