Use of flash glucose-sensing technology in patients with type 2 diabetes treated with liraglutide combined with CSII: a pilot study

Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4–10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (–0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [–2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.

血糖变异性（Glycemic variability, GV）可通过诱导炎症、氧化应激及内皮功能障碍，与糖尿病并发症的发生发展相关联。动态血糖监测（Flash glucose monitoring, FGM）是一种可连续监测组织间液葡萄糖水平的新型手段，监测时长可达14天。本研究将60例（n=60）接受二甲双胍联合每日多次胰岛素注射治疗、血糖控制不佳的2型糖尿病患者，在住院期间随机分为两组：持续皮下胰岛素输注（Continuous Subcutaneous Insulin Infusion, CSII）组，以及持续皮下胰岛素输注联合利拉鲁肽（CSII+Lira）组，干预周期为14天。研究采用动态血糖监测系统评估血糖变异性，同时检测受试者体重与心血管代谢生物标志物。结果显示，CSII+Lira组的变异系数显著降低（P<0.001），而CSII组未观察到显著变化。两组在血糖波动平均幅度（mean amplitude of glycemic excursions, P=0.004）、标准差（P=0.006）以及目标范围内时间占比（4~10 mmol/L，P=0.005；>10 mmol/L，P=0.028）的变化差异均具有统计学意义。动态血糖监测系统测得的每日差异均值、四分位间距，以及低血糖（<3.3 mmol/L）、高血糖（>13.9 mmol/L）的时间占比变化在两组间无显著差异。利拉鲁肽治疗可升高血清脂联素水平[33.5 (3.5, 47.7) pg/mL，P=0.003]与血红素氧合酶-1水平[0.4 (0, 1.8) ng/mL，P=0.001]，并降低血清瘦素水平[-2.8 (3.9) pg/mL，P<0.001]。加用胰高糖素样肽-1类似物利拉鲁肽，可改善血糖变异性、体重及部分心血管代谢风险标志物。因此，本研究证实动态血糖监测系统是一种新颖且实用的血糖监测手段。