Channabasappa Shivaprasad: Department of Endocrinology, Sapthagiri Institute of Medical Sciences and Research Centre (SIMS&RC), Bangalore, India. ORCID
Kolla Gautham: Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre (VIMS&RC), Bangalore, India.
Kejal Shah: Department of Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.
Soumya Gupta: Department of Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.
Preethika Palani: Department of Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.
Biswas Anupam: Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre (VIMS&RC), Bangalore, India.
BACKGROUND: Detailed evaluations of hypoglycemia and associated indices based on continuous glucose monitoring (CGM) are limited in patients with diabetes of the exocrine pancreas. Our study sought to evaluate the frequency and pattern of hypoglycemic events and to investigate hypoglycemia-specific indices in this population. METHODS: This was a cross-sectional study comprising 83 participants with diabetes of the exocrine pancreas. CGM and self-monitoring of blood glucose (SMBG) were performed on all participants for a minimum period of 72 hours. The frequency and pattern of hypoglycemic events, as well as hypoglycemia-related indices, were evaluated. RESULTS: Hypoglycemia was detected in 90.4% of patients using CGM and 38.5% of patients using SMBG. Nocturnal hypoglycemic events were more frequent (1.9 episodes/patient) and prolonged (142 minutes) compared with day-time events (1.1 episodes/patient; 82.8 minutes, < 0.05). The mean low blood glucose index was 2.1, and glycemic risk assessment diabetes equation hypoglycemia was 9.1%. The mean time spent below (TSB) <70 mg/dL was 9.2%, and TSB <54 mg/dL was 3.7%. The mean area under curve (AUC) <70 mg/dL was 1.7 ± 2.5 mg/dL/hour and AUC <54 mg/dL was 0.6 ± 1.3 mg/dL/hour. All of the CGM-derived hypoglycemic indices were significantly more deranged at night compared with during the day ( < 0.05). CONCLUSION: Patients with diabetes of the exocrine pancreas have a high frequency of hypoglycemic episodes that are predominantly nocturnal. 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.
