Title:Comparative Effectiveness of Oral Hypoglycemic Agents for Glycemic Control and Glycemic Variability in Patients with Type 2 Diabetes Mellitus: Using Flash Glucose Monitoring
Volume: 21
Issue: 1
Author(s): Poongothai Venkatachalapathy, Karthik Kumar Dos Alagarswamy Mohandoss, Murali Munisamy and Mohan Sellappan*
Affiliation:
- Department of Pharmacy Practice, Karpagam College of Pharmacy, Coimbatore, Tamil Nadu, India
Keywords:
Glycemic control, glycemic variability, type 2 diabetes mellitus, oral hypoglycemic agents, flash glucose monitoring, ambulatory glucose profile.
Abstract:
Aim: The study aimed to compare the effectiveness of oral hypoglycemic agents
(OHAs) as monotherapy, dual and quadruple therapy for glycemic control (GC) and glycemic
variability (GV) in patients with type 2 diabetes (T2DM) using flash glucose monitoring system
(FGM).
Background: Diabetes management largely relies on HbA1c monitoring. Glycemic variability
has been an evolving glycemic target for preventing complications related to type 2 diabetes
mellitus.
Objective: The purpose of the study was to compare glycemic control measures and glycemic
variability measures among study groups and to study the relationships between GC and GV indices.
Methods: Retrospectively, FGM data were collected from 50 T2DM patients. The patients were
classified based on prescribed number of OHAs as monotherapy [group 1: Dipeptidyl peptidase-
4 (DPP-4) inhibitors (n=10), group 2: Sodium-glucose co-transporter-2 (SGLT2) inhibitors
(n=10), group 3: Sulphonylureas (n=10), group 4: Dual therapy (n=10), and group 5: Quadruple
therapy (n=10)]. Measures of GC and GV were evaluated.
Results: Significant differences between study groups were observed in GC and GV measurements.
The SGLT2 inhibitors monotherapy group demonstrated optimal GC [eA1c (%): 6.5 ±
2.2; MBG: 140.80 ± 63.94; TIR: 60.60 ± 19.96] and GV (SD: 42.38 ± 34.57; CV: 27.85 ± 6.68;
MAGE: 96.76 ± 52.47; MODD: 33.96 ± 22.91) in comparison to other study groups. On using
Pearson correlation analysis, mean blood glucose (MBG) and mean amplitude of glycemic excursion
(MAGE) showed moderate correlation (r = 0.742)(r2 = 0.551), depicting distinct glucose
variabilities at the same mean blood glucose levels.
Conclusion: The monotherapy group of SGLT2 inhibitors demonstrated glucose-lowering effects
with reduced glycemic variability. Hence, optimum glycemic control is associated with
decreased glycemic variability.
