Evaluation of glycemic variability in chronic liver disease patients with type 2 diabetes mellitus using continuous glucose monitoring - PubMed (original) (raw)

. 2018 Apr 3;13(4):e0195028.

doi: 10.1371/journal.pone.0195028. eCollection 2018.

Akira Hiramatsu 1, Hideyuki Hyogo 2, Hiroshi Aikata 1, Kana Daijo 1, Yuji Teraoka 1, Yuki Inagaki 1, Kei Morio 1, Tomoki Kobayashi 1, Takashi Nakahara 1, Yuko Nagaoki 1, Tomokazu Kawaoka 1, Masayasu Yoneda 3, Masataka Tsuge 1, Michio Imamura 1, Yoshiiku Kawakami 1, Hidenori Ochi 1, Kazuaki Chayama 1

Affiliations

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

Fumi Honda et al. PLoS One. 2018.

Abstract

Background and aims: 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).

Materials and methods: 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.

Results and discussion: 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.

Conclusion: 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%.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1

Fig 1. Comparison of CGM parameters in three groups according to liver functional reserve (CH group, Child A group and Child B and C group).

(A) Mean blood glucose (MBG), (B) delta change in blood glucose (ΔBG), (C) mean amplitude of glycemic excursion (MAGE), (D) standard deviation of blood glucose (SDBG), (E) area under the curve of blood glucose above 140 mg/dl, (AUCgluc ≥ 140) and (F) area under the curve of blood glucose below 70 mg/dl (AUCgluc < 70) according to the severity of background liver disease in patients with chronic hepatitis (CH), Child-Pugh grade A and Child-Pugh B and C. In these box-and-whisker plots, lines within the boxes represent median values; the upper and lower lines of the boxes represent the 25th and 75th percentiles, respectively; and the upper and lower bars outside the boxes represent the 90th and 10th percentiles, respectively.

Fig 2

Fig 2. Comparison of CGM parameters between CH group and LC group among patients with HbA1c levels of ≥ 7.0%.

(A) MBG, (B) ΔBG, and (C) MAGE. The population of patients whose values were more than or equal to the cutoff values were compared between CH patients and LC patients. MBG: mean blood glucose, ΔBG: the difference between the highest blood glucose and the lowest blood glucose, MAGE: mean amplitude of glycemic excursion, CH: chronic hepatitis, LC: liver cirrhosis.

Fig 3

Fig 3. Comparison of CGM parameters between CH group and LC group among non-anemic patients with HbA1c levels of < 7.0%.

(A) MBG, (B) ΔBG, and (C) MAGE. The population of patients whose values were more than or equal to the cutoff values were compared between CH patients and LC patients. MBG: mean blood glucose, ΔBG: the difference between the highest blood glucose and the lowest blood glucose, MAGE: mean amplitude of glycemic excursion, CH: chronic hepatitis, LC: liver cirrhosis.

References

    1. El-Serag HB, Tran T, Everhart JE. Diabetes increase the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology 2004;126:460–468. - PubMed
    1. de Marco R, Locatelli F, Zoppini G, Verlato G, Bonora E, Muggeo M, et al. : Cause-specific mortality in type 2 diabetes: The Verona Diabetes Study. Diabetes Care 1999;22:756–761. - PubMed
    1. Balkau B, Eschwege E, Ducimetiere P, Richard JL, Warnet JM: The high risk of death by alcohol related diseases in subjects diagnosed as diabetic and impaired glucose tolerant: the Paris Prospective Study after 15 years of follow-up. J Clin Epidemiol 1991;44:465–474. - PubMed
    1. Petrides AS. Liver disease and diabetes mellitus. Diabetes Rev 1994;2:2–18.
    1. Giampaolo B, Giulio M, Marco Z, Elizabetta B, Andrea F, Emilio P, et al. Prognostic significance of diabetes in patients with cirrhosis, Hepatology 1994;20:119–125. - PubMed

MeSH terms

Substances

LinkOut - more resources