Efficacy and safety of liraglutide added to insulin therapy in elderly patients with type 2 diabetes.

INTRODUCTION: The combination of GLP-1 receptor agonists and insulin is effective in type 2 diabetes (T2D) treatment. However, its longitudinal efficacy and safety in elderly patients have not been established. We evaluated whether liraglutide (Lira) added to insulin therapy safely improved glycaemic control in T2D patients aged >65 years. METHODS: Twenty T2D patients receiving insulin were recruited, and Lira was added to their treatment regimen. Before and 6 months after Lira was added, we assessed the metabolic parameters and continuous glucose monitoring (CGM) data. RESULTS: Six months after Lira was added, the levels of HbA1c and glycated albumin and body weight were significantly improved, despite the daily doses and number of insulin injections per day being reduced. CGM analysis revealed that the SD and AUC of glucose >180 mg/dL were significantly decreased; the proportion of hypoglycaemic events was not increased. CONCLUSION: Lira administration safely improved glycaemic control and reduced body weight. Lira added to insulin therapy may improve the quality of life in elderly T2D patients undergoing insulin therapy, especially those requiring social support.

Durability of Glucose-Lowering Effect of the First Administration of Dulaglutide: A Retrospective, Single-Center, Single-Arm Study.

INTRODUCTION: Dulaglutide (Dula) is a once-weekly glucagon-like peptide-1 receptor agonist that efficiently reduces the level of glycated hemoglobin (HbA1c) in patients with type 2 diabetes (T2D). However, the durability of the glucose-lowering effect of the first injection of Dula (1st Dula) remains unclear. METHODS: This study had a retrospective, single-center, and single-arm design in a clinical setting and was conducted between April 2016 and March 2017. We investigated the changes and fluctuations in glucose level in 15 patients with T2D using a continuous glucose monitor, from 1 day before the first administration of Dula to 6 days thereafter. RESULTS: The mean glucose levels decreased significantly from 1 day before 1st Dula up to 5 days thereafter, whereas the standard deviation, mean amplitude of glucose excursion, and percentage of the glucose levels > 180 mg/dL were significantly improved only up to 3, 2, and 3 days after the 1st Dula, respectively, compared to those before administration. CONCLUSION: The effect of blood glucose regulation after the 1st Dula did not continue for a whole week. These effects should be considered when adjusting for other hypoglycemic agents.

Insulinoma Presenting with Reactive Hypoglycemia: Evaluating the Effect of Tumor Resection via Continuous Glucose Monitoring.

A 71-year-old woman previously diagnosed with reactive hypoglycemia was transferred to our emergency unit because of loss of consciousness. Her plasma glucose level was 27 mg/dL, and continuous glucose monitoring (CGM) revealed postprandial asymptomatic hypoglycemia. A hypervascular tumor was identified via computed tomography in the distal pancreas, and the diagnosis of insulinoma was confirmed using the selective arterial calcium stimulation test. Although no episodes of hypoglycemia were observed during CGM after resection, a pathological examination identified regional lymph node metastasis. It is important to consider insulinoma as a cause of postprandial hypoglycemia, and CGM is useful for evaluating treatment outcomes.

Continuous Glucose Monitoring in Patients with Abnormal Glucose Tolerance during Pregnancy: A Case Series.

Abnormal glucose tolerance during pregnancy is associated with perinatal complications. We used continuous glucose monitoring (CGM) in pregnant women with glucose intolerance to achieve better glycemic control and to evaluate the maternal glucose fluctuations. We also used CGM in women without glucose intolerance (the control cases). Furthermore, the standard deviation (SD) and mean amplitude of glycemic excursions (MAGE) were calculated for each case. For the control cases, the glucose levels were tightly controlled within a very narrow range; however, the SD and MAGE values in pregnant women with glucose intolerance were relativity high, suggesting postprandial hyperglycemia. Our results demonstrate that pregnant women with glucose intolerance exhibited greater glucose fluctuations compared with the control cases. The use of CGM may help to improve our understanding of glycemic patterns and may have beneficial effects on perinatal glycemic control, such as the detection of postprandial hyperglycemia in pregnant women.