In the Journals

Glucose control after breakfast improved HbA1c in type 1 diabetes

In patients with type 1 diabetes, glucose improvement during the period after breakfast appears to be influential in reducing HbA1c levels, according to recent study findings. Additionally, the study researchers found that improvements in overnight glucose control yielded improvements in ensuing breakfast-time glucose.

“Improving breakfast meal period glucose levels had the greatest independent effect on lowering HbA1c levels in patients with type 1 diabetes, and improved overnight control had a sustained effect associated with lower [continuous glucose monitoring]-glucose levels during the morning,” David M. Maahs, MD, PhD, of the Barbara Davis Center for Childhood Diabetes in Aurora, Colo., and colleagues wrote. “Although glucose control should be improved at all times, methods to improve overnight and post-breakfast glucose levels may be of primary importance in improving glucose control in patients with type 1 diabetes.”

The researchers evaluated 196 patients from the STAR 3 study database aged 7 to 70 years who had type 1 diabetes.

The patients were randomly assigned to undergo sensor-augmented pump therapy. Their glucose levels were collected for roughly 1 week at baseline, and then continuously throughout the study. All levels studied were recorded using continuous glucose monitoring (CGM). The researchers utilized the complete days of the baseline period and the measurements taken during the final month of the study to compare glucose changes. HbA1c levels also were measured at baseline and after 1 year.

Changes in HbA1c and mean glucose from baseline to 12 months were calculated, as well as mean glucose levels for each meal period.

Mean glucose level changes for each meal period were compared based on four improvement categories: daytime and overnight, daytime only, overnight only, and no improvement.

The researchers found that improvements in HbA1c levels after 1 year were related to mean glucose levels during the daytime period (6 a.m. to midnight) overnight (midnight to 6 a.m.), and at each meal time period (P<.0001 for each). Multivariable analysis revealed that only improvement in breakfast meal period glucose levels was independently associated with improvement in HbA1c after 1 year (–0.46%, P<.0001).

Additionally, patients who did not demonstrate overall daily improvement but demonstrated improved glucose during the overnight interval had a related 26 ± 22 mg/dL improvement in breakfast meal period glucose (P<.01).

Disclosure: Three of the researchers are employees of Medtronic.