Factors influencing inter-day glycemic variability in diabetic outpatients receiving insulin therapy

Introduction: The aim of the present study was to determine the actual state of interday glycemic variability and identify the factors that affect glycemic variability in diabetic outpatients on insulin therapy. Materials and Methods: The participants were 45 outpatients with diabetes mellitus receiving insulin therapy. The mean plasma glucose (MPG) levels, intra-day glycemic variability (expressed by standard deviation and mean amplitude of glucose excursion) and inter-day glycemic variability (expressed by mean of daily differences [MODD] in blood glucose levels) were measured continuously over 7 days with iPro2 (R). The primary outcome was the relationship between MODD and the life variability index. Results: MODD values were high in 93.3% of the participants, and significantly higher in patients with lifestyle changes than in those without (higher in patients with high life variability index). MODD values were not associated with age, but significantly higher in women. MODD values correlated significantly with glycated hemoglobin and glycoalbumin levels, and negatively with 1,5-anhydroglucitol levels. MODD values were significantly higher in type 1 diabetes patients and not associated with duration of disease. MODD values correlated significantly with insulin dose. Multivariate analysis identified the life variability index as a significant determinant of MODD. Conclusions: iPro2 (R) provided detailed information on glycemic profile in diabetic outpatients receiving insulin therapy. The results suggest that patients with large inter-day glycemic variability are unlikely to achieve an improvement in their glycated hemoglobin level. Treatment and instructions based on a patient's characteristics, day-to-day glycemic variability and lifestyle are important to achieve good glycemic control.