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Factors associated with nocturnal and diurnal glycemic variability in patients with type 2 diabetes: a cross-sectional study

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Abstract

Purpose

There is little information on factors that influence the glycemic variability (GV) during the nocturnal and diurnal periods. We aimed to examine the relationship between clinical factors and GV during these two periods.

Methods

This cross-sectional study included 134 patients with type 2 diabetes. 24-h changes in blood glucose were recorded by a continuous glucose monitoring system. Nocturnal and diurnal GV were assessed by standard deviation of blood glucose (SDBG), coefficient of variation (CV), and mean amplitude of glycemic excursions (MAGE), respectively. Robust regression analyses were performed to identify the factors associated with GV. Restricted cubic splines were used to determine dose–response relationship.

Results

During the nocturnal period, age and glycemic level at 12:00 A.M. were positively associated with GV, whereas alanine aminotransferase was negatively associated with GV. During the diurnal period, homeostatic model assessment 2-insulin sensitivity (HOMA2-S) was positively associated with GV, whereas insulin secretion-sensitivity index-2 (ISSI2) was negatively associated with GV. Additionally, we found a J-shape association between the glycemic level at 12:00 A.M. and MAGE, with 9.0 mmol/L blood glucose level as a cutoff point. Similar nonlinear associations were found between ISSI2 and SDBG, and between ISSI2 and MAGE, with ISSI2 value of 175 as a cutoff point.

Conclusion

Factors associated with GV were different between nocturnal and diurnal periods. The cutoff points we found in this study may provide the therapeutic targets for beta-cell function and pre-sleep glycemic level in clinical practice.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by National Natural Science Foundation of China [82073648], Shandong Research Hospital Association [2022023], Shandong Provincial Natural Science Foundation [ZR2021QH135], Doctoral Fund of Jining NO.1 People’s Hospital [2022-BS-008], and Traditional Chinese Medicine Science and Technology Development Plan of Shandong Province [Q-2022026]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. J. Jiang and Z. Xia equally contributed as first authors.

  2. Y. He and J. Sun equally contributed as corresponding authors.

Authors and Affiliations

  1. Department of Endocrinology, Jining No. 1 People’s Hospital, 6 Jiankang Road, Rencheng District, Jining, 272000, Shandong, China

    J. Jiang, F. Li, W. Wang, S. Ding, J. Zhang & J. Sun

  2. Postdoctoral of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China

    J. Jiang

  3. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing, 100069, China

    Z. Xia, D. Zheng, Y. Li, X. Su, Q. Zhai, Y. Zuo, Y. Zhang & Y. He

  4. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China

    D. Zheng & Y. He

  5. Departments of Medicine and Physiology, University of Toronto, Toronto, ON, Canada

    H. Y. Gaisano

Authors
  1. J. Jiang
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  2. Z. Xia
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  8. J. Zhang
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  9. X. Su
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  14. Y. He
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  15. J. Sun
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Contributions

Conceptualization: JJ, ZX, YH. Methodology: ZX, DZ, YZ, YH. Acquisition of data: JJ, FL, WW, SD, JZ, JS. Formal analysis: ZX. Interpretation of data: JJ, ZX, YL, YH, JS. Writing—original draft preparation: ZX. Writing—review and editing: JJ, DZ, YL, XS, QZ, YZ, YZ, HYG, YH, JS. Funding acquisition: JJ, YH. Supervision: JJ, YH. Final approval of the manuscript: All authors.

Corresponding authors

Correspondence to Y. He or J. Sun.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Medical Ethics Committee of Shandong First Medical University (No. JNMC-2022-YX-019).

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The requirement for informed consent was waived because we used deidentified retrospective data.

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Jiang, J., Xia, Z., Zheng, D. et al. Factors associated with nocturnal and diurnal glycemic variability in patients with type 2 diabetes: a cross-sectional study. J Endocrinol Invest 47, 245–253 (2024). https://doi.org/10.1007/s40618-023-02142-z

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  • DOI: https://doi.org/10.1007/s40618-023-02142-z

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