Are glucose profiles well-controlled within the targets recommended by the International Diabetes Federation in type 2 diabetes? A meta-analysis of results from continuous glucose monitoring based studies

AIMS: To assess continuous glucose monitoring (CGM) derived intra-day glucose profiles using global guideline for type 2 diabetes recommended by the International Diabetes Federation (IDF). METHODS: The Cochrane Library, MEDLINE, PubMed, CINAHL and Science Direct were searched to identify observational studies reporting intra-day glucose profiles using CGM in people with type 2 diabetes on any anti-diabetes agents. Overall and subgroup analyses were conducted to summarise mean differences between reported glucose profiles (fasting glucose, pre-meal glucose, postprandial glucose and post-meal glucose spike/excursion) and the IDF targets. RESULTS: Twelve observational studies totalling 731 people were included. Pooled fasting glucose (0.81 mmol/L, 95% CI, 0.53-1.09 mmol/L), postprandial glucose after breakfast (1.63 mmol/L, 95% CI, 0.79-2.48 mmol/L) and post-breakfast glucose spike (1.05 mmol/L, 95% CI, 0.13-1.96 mmol/L) were significantly higher than the IDF targets. Pre-lunch glucose, pre-dinner glucose and postprandial glucose after lunch and dinner were above the IDF targets but not significantly. Subgroup analysis showed significantly higher fasting glucose and postprandial glucose after breakfast in all groups: HbA1c <7% and ≥7% (53 mmol/mol) and duration of diabetes <10 years and ≥10 years. CONCLUSIONS: Independent of HbA1c, fasting glucose and postprandial glucose after breakfast are not well-controlled in type 2 diabetes

Dose-response between frequency of breaks in sedentary time and glucose control in type 2 diabetes: a proof of concept study

Objectives This study aimed to investigate dose-response between frequency of breaks in sedentary time and glucose control.DesignRandomised three-treatment, two-period balanced incomplete block trial.MethodsTwelve adults with type 2 diabetes (age, 60 ± 11 years; body mass index, 30.2 ± 4.7 kg/m2) participated in two of the following treatment conditions: sitting for 7 h interrupted by 3 min light-intensity walking breaks every (1) 60 min (Condition 1), (2) 30 min (Condition 2), and (3) 15 min (Condition 3). Postprandial glucose incremental area under the curves (iAUCs) and 21-h glucose total area under the curve (AUC) were measured using continuous glucose monitoring. Standardised meals were provided. Results Compared with Condition 1 (6.7 ± 0.8 mmol L−1 × 3.5 h−1), post-breakfast glucose iAUC was reduced for Condition 3 (3.5 ± 0.9 mmol L−1 × 3.5 h−1, p ˂ 0.04). Post-lunch glucose iAUC was lower in Condition 3 (1.3 ± 0.9 mmol L−1 × 3.5 h−1, p ˂ 0.03) and Condition 2 (2.1 ± 0.7 mmol L−1 × 3.5 h−1, p ˂ 0.05) relative to Condition 1 (4.6 ± 0.8 mmol L−1 × 3.5 h−1). Condition 3 (1.0 ± 0.7 mmol L−1 × 3.5 h−1, p = 0.02) and Condition 2 (1.6 ± 0.6 mmol L−1 × 3.5 h−1, p ˂ 0.04) attenuated post-dinner glucose iAUC compared with Condition 1 (4.0 ± 0.7 mmol L−1 × 3.5 h−1). Cumulative 10.5-h postprandial glucose iAUC was lower in Condition 3 than Condition 1 (p = 0.02). Condition 3 reduced 21-h glucose AUC compared with Condition 1 (p < 0.001) and Condition 2 (p = 0.002). However, post-breakfast glucose iAUC, cumulative 10.5-h postprandial glucose iAUC and 21-h glucose AUC were not different between Condition 2 and Condition 1 (p ˃ 0.05).Conclusions There could be dose-response between frequency of breaks in sedentary time and glucose. Interrupting sedentary time every 15 min could produce better glucose control

Impact of free-living pattern of sedentary behaviour on intra-day glucose regulation in type 2 diabetes

Purpose: To investigate how the pattern of sedentary behaviour affects intra-day glucose regulation in type 2 diabetes. Methods: This intensive longitudinal study was conducted in 37 participants with type 2 diabetes (age, 62.8 ± 10.5 years). Glucose and sedentary behaviour/physical activity were assessed with a continuous glucose monitoring (Abbott FreeStyle Libre) and an activity monitor (activPAL3) for 14 days. Multiple regression models with generalised estimating equations (GEEs) approach were used to assess the associations of sedentary time and breaks in sedentary time with pre-breakfast glucose, pre-lunch glucose, pre-dinner glucose, post-breakfast glucose, post-lunch glucose, post-dinner glucose, bedtime glucose, the dawn phenomenon, time in target glucose range (TIR, glucose 3.9–10 mmol/L) and time above target glucose range (TAR, glucose > 10 mmol/L). Results: Sedentary time was associated with higher pre-breakfast glucose (p = 0.001), pre-dinner glucose (p < 0.001), post-lunch glucose (p = 0.005), post-dinner glucose (p = 0.013) and the dawn phenomenon (p < 0.001). Breaks in sedentary time were associated with lower pre-breakfast glucose (p = 0.023), pre-dinner glucose (p = 0.023), post-breakfast glucose (p < 0.001) and the dawn phenomenon (p = 0.004). The association between sedentary time and less TIR (p = 0.022) and the association between breaks in sedentary time and more TIR (p = 0.001) were also observed. Conclusions: Reducing sedentary time and promoting breaks in sedentary time could be clinically relevant to improve intra-day glucose regulation in type 2 diabetes

Measuring group and individual relationship between patterns in sedentary behaviour and glucose in type 2 diabetes adults

The aim of this study was to explore the relationship between patterns in sedentary behaviour and glucose in adults with type 2 diabetes. Thirty‐seven adults with type 2 diabetes managed with diet and/or anti‐diabetes medication (not insulin) were recruited. Participants wore an activPAL accelerometer and FreeStyle Libre flash glucose monitor for continuous measurement of activity and glucose for 24 hours/day for three to 14 days while documenting sleep, food and medication. The relationship between daily patterns of sedentary behaviour and sedentary breaks with glucose was investigated using correlation analysis. Regression analysis was used to investigate these relationships at an individual level. Participants (mean age 62.8±10.5 years, BMI 29.6±6.8kg/m2) spent 64% of their day sedentary, 44.7% of sedentary bouts were 30–60 minutes in duration and mean bout duration was 47.2 minutes. No association between mean glucose and sedentary proportion (total sedentary time) was identified. Mean glucose and glucose standard deviation were positively correlated with sedentary bout duration (both p<0.05). Individual regression analysis showed increased sedentary time is associated with increased mean glucose in 25 (68%) of the participants, with a negative association being shown in 12 (32%) of the participants. In analysis of the whole group, sedentary bout duration but not sedentary proportion was associated with mean glucose and glucose variability. Individual regression analysis identified a different relationship pattern for the majority of participants. This is the first study to identify an individualised response to activity behaviour and highlights the importance of conducting individual analysis when using continuous measurement methods