Evaluation Of Short-term Intensive Insulin Therapy For T2DM With Flash Glucose Monitoring System

Objective: This study aimed to evaluate the efficacy and safety of basal mealtime and 3 premixed short-term intensive insulin therapy for glycemic control in T2 DM using the FGM system.Methods: From May 26,2020 to February 11,2021,76 hospitalized patients with T2 DM were enrolled.They were treated with basal meal or thrice-daily premixed insulin intensification treatments for 7-14 days.FGM sensors were worn to observe blood glucose control levels and blood glucose fluctuations,occurrence of hypoglycemia and weight changes.Blood glucose level parameters: MG,GMI,TIR and TAR,Grade 1 TAR,Grade 2 TAR,TBR,1 h MG before meals,3 h MG after meals,serum 1,5-AG,serum GA.Blood glucose fluctuation parameters:CV,SD,MAGE,LAGE.Hypoglycemia assessment indicators: TBR,grade 1 TBR,Grade 2 TAR,incidence of hypoglycemia and incidence of hypoglycemic events.The correlation between weight changes and average daily insulin dose,TIR with 1,5-AG and GA,and the incidence of hypoglycemic events with MG were analyzed.Results: 1.The blood glucose levels were compared before and after: MG,GMI,GA,1 h MG before meals,3 h MG after meals,TAR,and grade 1 and 2 TAR decreased（P<0.05）,TIR and 1,5-AG increased（P<0.05）,and the TBR change was not statistically significant（P>0.05）.Comparison between groups: There were no significant difference in the changes of blood glucose levels before and after treatment and the overall level during treatment between the two groups（P>0.05）.2.Comparison of blood glucose fluctuation levels before and after: SD,MAGE,LAGE all decreased（P<0.05）,and CV did not change significantly（P>0.05）.There was no significant difference in the changes of blood glucose fluctuation parameters（P>0.05）,the overall CV of the basic meal group was lower than that of the three-time premix group（P<0.05）,and there was no significant difference in the SD,MAGE,and LAGE overall levels between groups（P>0.05）.3.Changes in body weight: After treatment,the body weight of the two groups showed an rising trend,and the weight gain in the basic meal group was statistically significant（p<0.05）,but the weight gain in the 3 times premixed group was not statistically significant（p>0.05）.There was no statistical difference between groups in body weight change and mean body weight at the end of treatment（P>0.05）.4.Safety comparison:FGM has a higher incidence of hypoglycemia events and hypoglycemia compared with fingertip blood glucose.There was no significant difference in the incidence of hypoglycemic events,the incidence of grade 1 hypoglycemic events,the incidence of grade 2 hypoglycemic events and the incidence of nocturnal hypoglycemic events monitored by FGM system between the two groups（P>0.05）.The incidence of nocturnal hypoglycemia and nocturnal hypoglycemic events were higher in the 3 times premixed group.5.Correlation analysis between1,5-AG and GA and TIR: 1,5-AG was not significantly correlated with TIR,while GA was negatively correlated with TIR.Conclusion: FGM data suggest that both basal prandial insulin and short-term intensive treatment with premixed insulin three times a day in T2 DM can significantly improve blood sugar,and the level of blood sugar improvement during treatment and overall blood sugar levels are similar.Compared with fingertip blood sugar,FGM hypoglycemia has a higher event rate and hypoglycemia rate,and the overall blood sugar fluctuation of the basal meal insulin regimen may be smaller,and the risk of nighttime hypoglycemia is smaller.