Dawn Phenomenon Affects Half of Type 2 Diabetes Patients
The dawn phenomenon refers to a spontaneous rise in blood glucose that occurs at the end of the night in patients with both type 1 and type 2 diabetes; this does not occur in individuals without diabetes, because endogenously produced insulin prevents this.
The findings indicate that in selected type 2 diabetes patients, specifically those with HbA1c approaching 7% who are demonstrating evidence of the dawn phenomenon, insulin use should be considered earlier than it is traditionally, because insulin can eliminate this effect, said Geremia B Bolli, MD, from the University of Perugia, Italy.
”We have defined the frequency of the dawn phenomenon in type 2 diabetes, which in the present paper occurs in around 50% of patients, and this definition is more accurate than previous ones due to our use of continuous glucose monitoring [CGM] systems,” Dr. Monnier told Medscape Medical News.
In addition, he and his colleagues quantify the effect of this phenomenon, showing that the mean impact on HbA1c was around a 0.4% rise. ”This may seem small,” said Dr. Monnier, ”but when one considers that treatment with, for example, [dipeptidyl peptidase-4] DPP-4 inhibitors [gliptins], results in a mean drop in HbA1c of only around 0.7% to 0.8% [as well as] that a drop of 1.0% in HbA1c can reduce macrovascular complications by 40% and microvascular ones by 37%,” then one can gauge the significance.
Dr. Monnier agrees with Dr. Bolli that the new findings indicate that insulin use should be considered earlier for type 2 diabetes patients showing evidence of the dawn phenomenon. ”We are unable to control the dawn phenomenon with our current armamentarium of oral hypoglycemic agents, even though metformin is probably the one that has the highest potency for reducing [it]. My position is that insulin should be considered for the treatment of type 2 diabetes as soon as the HbA1c becomes greater than 7% when patients are already treated with maximal tolerated doses of oral agents,” he told Medscape Medical News.
Dr. Monnier and colleagues’ study is October 29 in Diabetes Care.
From http://www.medscape.com
Abstract
Magnitude of the Dawn Phenomenon and Its Impact on the Overall Glucose Exposure in Type 2 DiabetesIs
- Louis Monnier, MD1⇑,
- Claude Colette, PhD1,
- Sylvie Dejager, MD, PhD2 and
- David Owens, MD3
+ Author Affiliations
- Corresponding author: Louis Monnier, louis.monnier@inserm.fr.
Abstract
OBJECTIVE To assess the magnitude of the dawn phenomenon and its impact on the total glucose exposure in type 2 diabetes
RESEARCH DESIGN AND METHODS A total of 248 noninsulin-treated persons with type 2 diabetes who underwent continuous glucose monitoring were divided into three groups selected by treatments: diet alone (n = 53); insulin sensitizers alone (n = 82); and insulin secretagogues alone or in combination with insulin sensitizers (n = 113). The dawn phenomenon (∂ glucose, mg/dL) was quantified by its absolute increment from nocturnal nadir to prebreakfast value. The participants were secondarily divided into two paired subsets after they had been separated by the presence/absence of a dawn phenomenon based on a threshold of 20 mg/dL and matched for glucose nadir. The impact of the dawn phenomenon was assessed on HbA1c and 24-h mean glucose.
RESULTS The median of ∂ glucose (interquartile range) was 16.0 (0–31.5 mg/dL) in the 248 subjects, and no differences were observed across groups selected by HbA1c or treatments. In the overall population, the mean impacts on HbA1c and 24-h mean glucose were 4.3 ± 1.3 mmol/mol (0.39 ± 0.12%) and 12.4 ± 2.4 mg/dL, respectively. The mean impact on 24-h mean glucose was not statistically different between those on diet alone (16.7 ± 5.9 mg/dL) compared with the two subsets treated with oral hypoglycemic agents (11.2 ± 5.3 and 8.5 ± 7.5 mg/dL).
CONCLUSIONS The impact of the dawn phenomenon on overall glycemic control in type 2 diabetes, as depicted by the HbA1c level, was ∼0.4% and not eliminated by any of the currently available armamentarium of oral antidiabetic agents.
Nyhetsinfo
www red DiabetologNytt
