Glucose variability assessed by low blood glucose index is predictive of hypoglycemic events in patientswith type 1 diabetes switched to pump therapy

Abstract

OBJECTIVE-To determine whether subgroups of type 1 diabetic patients with different glucose variability indices respond differently to continuous subcutaneous insulin infusion (CSII) in terms of reduced hypoglycemic events. RESEARCH DESIGN ANDMETHODSdWe studied 50 adults with long-standing type 1 diabetes switched to CSII because of persistently high A1C or frequent hypoglycemia despite well-managed intensive basal-bolus therapy. We compared A1C, hypoglycemic events, and glucose variability from self-monitoring of blood glucose profiles at baseline and after 6 months of CSII. Regression analysis was performed to identify predictors of response. RESULTS-In multivariate analysis, baseline low blood glucose index (LBGI) was the best independent predictor of hypoglycemia outcome on CSII (R2 = 0.195, P = 0.0013). An ROC curve analysis demonstrated a sensitivity of 70.8% (95% CI 48.9-87.4) and specificity of 73.1% (52.2-88.4) by using the LBGI cutoff of 3.34 as predictor of reduction of hypoglycemia on CSII. By grouping patients by LBGI tertiles, we found a 23.3%reduction in hypoglycemic events (<60 mg/dL [3.3 mmol/L]) in the third tertile (range 4.18-9.34) without change in A1C (P<0.05). Conversely, the first tertile (range 0.62-2.05) demonstrated the greatest A1C reduction,20.99% (P = 0.00001), but with increasing hypoglycemia. CONCLUSIONS-Baseline LBGI predicts the outcome of type 1 diabetic patients who switch to CSII in terms of hypoglycemia. © 2013 by the American Diabetes Association.