CGM Use Could Improve Glucose Control in Diabetes of the Exocrine Pancreas

New data from a cross-sectional study of patients with diabetes of the exocrine pancreas is providing clinicians with an overview of the ability of continuous glucose monitoring to detect hypoglycemia in this patient population.

Conducted by investigators from the Vydehi Institute of Medical Sciences and Research Center in India, results of the study indicate patients with diabetes of the exocrine pancreas experienced a high rate of hypoglycemic events that were predominantly nocturnal and continuous glucose monitoring was super to self-monitoring of blood glucose in the detection of both nocturnal and asymptomatic hypoglycemic episodes.

“In this study, we used CGM to assess hypoglycemic events and hypoglycemia-associated indices in patients with diabetes of the exocrine pancreas. We found that the majority of patients experienced hypoglycemic events with significant alterations in hypoglycemic indices,” wrote investigators.

Although application of continuous glucose monitoring has been examined extensively in recent years, data related to use for detection of hypoglycemia in patients with diabetes of the exocrine pancreas remains limited. With this in mind, a team led by Biswas Anupam, MD, DM, designed the current study with the intent of using continuous glucose monitoring to assess the frequency and pattern of hypoglycemic events as well as estimate multiple hypoglycemic-specific indices in a cohort of patients with diabetes of the exocrine pancreas.

For their study, investigators recruited patients aged 18-65 years of age diagnosed with diabetes of the exocrine pancreas for at least 3 months and under regular follow-up. Patients included in the study were identified from a registry of patients at an endocrine clinic in India and invited to participate over the phone. For the purpose of analysis, diabetes of the exocrine pancreas included post-pancreatic cancer diabetes mellitus, pancreatic cancer-related diabetes, and cystic fibrosis-related diabetes.

All patients included in the study underwent continuous glucose monitoring and self-monitoring of blood glucose for a minimum period of 72 hours inside a hospital. Of note, self-monitoring of blood glucose was performed before breakfast, lunch, and dinner as well as 2 hours after dinner, midnight, 3 A.M., and whenever the patient developed symptoms of hypoglycemia.

In total, 92 patients met eligibility criteria and were invited to participate in the study. The final cohort of patients included 83 patients. The mean age of participants was 35±8.2 years, the mean duration of diabetes was 5.1 years, the mean BMI was 18.9±2.8 kg/m2, and the mean HbA1c was 9.5±1.6%.

Investigators identified hypoglycemia among 90.4% of patients using continuous glucose m monitoring and 38.5% of patients using self-monitoring of blood glucose. Results suggested nocturnal hypoglycemic events were more frequent (1.9 vs 1.1 episodes per patient) and longer in duration (142 vs 82.8 minutes) compared to day-time events (P <.05). The mean low blood glucose index was 2.1 and the glycemic risk assessment diabetes equation hypoglycemia was 9.1%.

Additionally, the mean time spent below less than 70 mg/dL was 9.2% and the mean time spent below less than 54 mg/dL was 3.7%. The mean AUC less than 70 mg/dL was 1.7±2.5 mg/dL per hour and the AUC less than 54 mg/dL was 0.6±1.3 mg/dL per hour. All continuous glucose monitoring-derived hypoglycemic indices were significantly more deranged at night compared with during the day (P <.05).

“Patients with diabetes of the exocrine pancreas have a high frequency of hypoglycemic episodes that predominantly occur at night. CGM is superior to SMBG in the detection of nocturnal and asymptomatic hypoglycemic episodes. CGM-derived hypoglycemic indices are beneficial in estimating the risk of hypoglycemia,” wrote investigators.

This study, “Continuous Glucose Monitoring for the Detection of Hypoglycemia in Patients With Diabetes of the Exocrine Pancreas,” was published the Journal of Diabetes Science and Technology.