Kathleen Dungan1, Philip Binkley2, Kwame Osei3. 1. The Ohio State University Division of Endocrinology, Diabetes & Metabolism, 1581 Dodd Drive, Columbus, OH 43210. Electronic address: Kathleen.dungan@osumc.edu. 2. The Ohio State University Dorothy M. Davis Heart and Lung Research Institute, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210; The Ohio State University Division of Cardiovascular Medicine, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210. 3. The Ohio State University Division of Endocrinology, Diabetes & Metabolism, 1581 Dodd Drive, Columbus, OH 43210.
Abstract
AIMS: The objective of this study is to assess hypoglycemia and glycemic variability (GV) in hospitalized patients with and without heart failure (HF) exacerbation. METHODS: Hospitalized patients with type 2 diabetes (T2D) with (N=35) or without (N=16) HF who had hyperglycemia or significant insulin use were included. Subjects underwent continuous glucose monitoring during algorithmic titration of basal bolus insulin. RESULTS: HF subjects had lower glucose coefficient of variation ([CV], 31±12 vs. 22±8.2, p=0.02), lower Low Blood Glucose Index (LBGI) and less hypoglycemia (25% vs. 2.6%, p=0.02), but similar mean glucose and glycemic lability index as non-HF subjects on day 1, but not on day 2. Sensor CV was correlated with hypoglycemia (ρ 0.32, p=0.02), HF status (ρ -0.35, p=0.013), T2D duration (ρ 0.29, p=0.04), insulin use prior to admission (ρ 0.42, p=0.002) and catecholamine levels. After controlling for differences in age, HbA1c, hypoglycemia, catecholamine levels, QT interval, and beta blocker use, only HF and diabetes duration or insulin use prior to admission were independent predictors of CV. HF had less robust associations with LBGI in multivariable models. CONCLUSIONS: HF is not associated with increased GV or hypoglycemia risk during initial titration of insulin. Further research is needed to determine prognostic implications.
AIMS: The objective of this study is to assess hypoglycemia and glycemic variability (GV) in hospitalized patients with and without heart failure (HF) exacerbation. METHODS: Hospitalized patients with type 2 diabetes (T2D) with (N=35) or without (N=16) HF who had hyperglycemia or significant insulin use were included. Subjects underwent continuous glucose monitoring during algorithmic titration of basal bolus insulin. RESULTS: HF subjects had lower glucose coefficient of variation ([CV], 31±12 vs. 22±8.2, p=0.02), lower Low Blood Glucose Index (LBGI) and less hypoglycemia (25% vs. 2.6%, p=0.02), but similar mean glucose and glycemic lability index as non-HF subjects on day 1, but not on day 2. Sensor CV was correlated with hypoglycemia (ρ 0.32, p=0.02), HF status (ρ -0.35, p=0.013), T2D duration (ρ 0.29, p=0.04), insulin use prior to admission (ρ 0.42, p=0.002) and catecholamine levels. After controlling for differences in age, HbA1c, hypoglycemia, catecholamine levels, QT interval, and beta blocker use, only HF and diabetes duration or insulin use prior to admission were independent predictors of CV. HF had less robust associations with LBGI in multivariable models. CONCLUSIONS: HF is not associated with increased GV or hypoglycemia risk during initial titration of insulin. Further research is needed to determine prognostic implications.
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