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Liver Update: Evaluation of glycemic variability in CLD patients with type 2 diabetes mellitus using CGM.

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eMediNexus    25 November 2021

Patients with chronic liver disease (CLD) demonstrate marked blood glucose fluctuations. However, this dynamics is not well elaborated. A study evaluated glycemic fluctuations by continuous glucose monitoring (CGM).

The study enrolled 105 CLD patients with type 2 diabetes mellitus (T2DM) for investigating various parameters of glycemic variability. These parameters were evaluated for their link with a liver functional reserve and were also evaluated according to glycated hemoglobin A1c (HbA1c) levels.

The observations of the study were as follows-

  • An increase in mean blood glucose (MBG) levels and an increase in the difference between highest and lowest blood glucose (ΔBG) was significantly proportional to the worsening of liver functional reserve. 
  • Although being treated for diabetes, 92% of patients demonstrated postprandial hyperglycemia. 
  • 22% of patients demonstrated Nocturnal hypoglycemia. 
  • Non-anemic patients with HbA1c levels of < 7.0%, showed a higher percentage of patients with mean amplitude of glycemic excursion (MAGE) of ≥ 77.4 mg/dL and that of MBG levels of > 145 mg/dL in liver cirrhosis (LC) patients contrasting chronic hepatitis (CH) patients. 
  • Also, they had homeostasis model assessment for insulin resistance (HOMA-IR) of > 2.5 and LC significantly linked with the increase in MAGE. 
  • LC also showed a significant link with increased MBG levels.

Thus CGM systems can help detect abnormalities of blood glucose fluctuations in CLD patients with T2DM, particularly in non-anemic CLD patients with HbA1c levels of < 7.0%.

Source: PLoS ONE,2018; 13(4): e0195028. https://doi.org/10.1371/journal.pone.0195028

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