Glycemic Variability Assessment with a 14-Day Continuous Glucose Monitoring System: When and How Long to Measure MAGE (Mean Amplitude of Glucose Excursion) for Optimal Reliability?

Mean amplitude of glucose excursion (MAGE) is considered as the "gold standard" for assessing the short-term within-day glycemic variability (GV), which is an important component of overall glycemic control. A 14-day continuous glucose monitoring system is now widely used and allows easier assessment of GV. However, it is still unknown whether MAGE, usually calculated on a 48-hour period is identical whatever the time during the 14-day lifespan of the sensor and whether a longer time period might give additional information. We evaluated in 68 patients with type 1 diabetes, MAGE during three 2-day periods (day1-day3; day6-day8; day11-day13) and during periods of 3 days and 4 days. MAGE calculated at the three 2-day periods were identical and not different from MAGE of the 3-day or 4-day periods.

Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes.

BACKGROUND: Little is known about the prevalence of hypoglycaemia in older people with diabetes. However, the HbA1c goal is ≥8% for institutionalised patients with treatments that can cause hypoglycaemia. PURPOSE: We aimed to assess the prevalence of hypoglycaemia with continuous glucose monitoring and to evaluate the link with HbA1C in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. DESIGN: Prospective, multicentre study carried out in six geriatric care centres in the Côte d'Or region of France between January 2019 and July 2020. SETTINGS, SUBJECTS AND METHODS: A FreeStyle Libre Pro® (FSLP) was worn for up to 14 days in blinded mode in 42 patients taking at least one potentially hypoglycaemia-inducing antidiabetic drug. RESULTS: Two hundred and forty-two hypoglycaemic events were detected in 79% (n = 33) of patients wearing the FSLP. One or more hypoglycaemic event was detected in 100% of patients with HbA1C < 7% and in 79% of patients with HbA1C ≥ 8% (P = 0.02). The time spent in hypoglycaemia was higher in patients with HbA1C < 7% than those with HbA1C ≥ 8% (P = 0.015). Time spent <54 mg/dl was detected in 45% of patients. CONCLUSIONS: We report a very high prevalence of hypoglycaemia, with a significant proportion of severe hypoglycaemia, in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. Having HbA1C < 7% exposes patients to a higher risk of hypoglycaemia, but this risk remains also high in patients with HbA1C ≥ 8%. In this population, continuous glucose monitoring could be considered an effective tool to detect hypoglycemia, which is associated with increased risk of cardiovascular events, falling, fractures, cognitive impairment and mortality.

Are older patients with diabetes still being overtreated in French long-term care homes?

BACKGROUND: Diabetes management has not been evaluated in French nursing homes (NHs) for 10 years. OBJECTIVES: The present study aimed to compare the management of diabetes with guidelines in older patients living in NHs. DESIGN: Observational, retrospective and multicentre study carried out in 13 NH in the Cote d'Or region of France. SETTINGS AND SUBJECTS: Between January and June 2018, all NH residents older than 65 years and known to have diabetes (n = 148) were included. METHODS: Epidemiological, clinical and biological data and diabetes characteristics were collected from the medical records. RESULTS: The average glycated haemoglobin (HbA1C) was 7.2 ± 1.2%. In total, 51% of patients had HbA1C < 7% (n = 70), of which 39 took one or more antidiabetic drugs. In total, 28 of those patients (40%) were at risk of developing hypoglycaemia as a result of their treatment. In all, 44.6% of patients were treated with insulin. Glinides were the most commonly prescribed oral antidiabetic drug (OAD) (27%). Capillary blood glucose monitoring (CBGM) was not carried out daily for 75% of patients taking a potentially hypoglycaemia-inducing OAD. CONCLUSIONS: We found that glycaemic control was too tight in at least 36.5% of the total population and that 40% of patients with HbA1C < 7% were potentially overtreated. The use of dipeptidyl peptidase 4 (DPP-4) inhibitors was still insufficient, as was CBGM. Avoiding hypoglycaemia is one of the priorities in the management of older patients with diabetes. Therefore, NHs should focus on improving the use of glycaemic targets and antidiabetic drugs that do not induce hypoglycaemia, as well as better monitoring of capillary blood glucose.