Hypoglycemic timeslots after hospital discharge in patients with diabetes on multiple daily insulin injection: Dose of Insulin CHanged According to the Reported Glucose by Libre Pro (DISCHARGe study)
ABSTRACT Introduction Insulin improves clinical outcomes in hospitalized patients; however, hypoglycemia hinders discharge transition in patients with insulin‐treated diabetes. Studies on hypoglycemic timeslots, rates, and risk factors during discharge transition are lacking. Materials and Methods F...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-08-01
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| Series: | Journal of Diabetes Investigation |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/jdi.70065 |
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| Summary: | ABSTRACT Introduction Insulin improves clinical outcomes in hospitalized patients; however, hypoglycemia hinders discharge transition in patients with insulin‐treated diabetes. Studies on hypoglycemic timeslots, rates, and risk factors during discharge transition are lacking. Materials and Methods Fifteen patients with type 2 diabetes (T2D) receiving multiple daily insulin (MDI) injections participated. Glucose variability metrics and hypoglycemia were monitored using a continuous glucose monitoring system starting a day pre‐discharge through 13 days of discharge transition. Hypoglycemia was analyzed chronobiologically using Cosinor analysis. Anthropometric measurements, C‐peptide, insulin dose, and glucagon were assessed. Results The mean patient age was 52.7 ± 12.6 years; 13/15 were male; body mass index was 28.1 ± 5.9 kg/m2, T2D duration was 8.6 ± 8.8 years, HbA1c was 12.4 ± 2.5%, and total daily insulin dose averaged 36.6 ± 15.1 units and hospitalization lasted 13.1 ± 2.3 days. Time in range decreased post‐discharge. Time below range increased from 7.0% at discharge to 17.6% by the study end (manova, P < 0.001). Hypoglycemic events peaked post‐breakfast, with the highest amplitude (42 points) recorded at 12:00. The highest and lowest numbers of hypoglycemia occurred at 12:00 and 17:30, respectively. However, the highest hypoglycemic timeslot (11:00–12:00) was not significantly associated with clinical and biochemical parameters. Conclusions The chronobiology of hypoglycemia exists during the discharge transition in patients with MDI‐treated T2D. Hypoglycemia frequency and severity peaked pre‐lunch, reached a nadir at 17:30, and exaggerated post‐discharge, emphasizing the need for pre‐breakfast insulin dose reductions on the discharge day. |
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| ISSN: | 2040-1116 2040-1124 |