Enlarged glycemic variability in sulfonylurea-treated well-controlled type 2 diabetics identified using continuous glucose monitoring

Time in range (TIR) is an index of glycemic control obtained from continuous glucose monitoring (CGM). The aim was to compare the glycemic variability of treatment with sulfonylureas (SUs) in type 2 diabetes mellitus (T2DM) with well-controlled glucose level (TIR>70%). The study subjects were 123 patients selected T2DM who underwent CGM more than 24 h on admission without changing treatment. The primary endpoint was the difference in glycemic variability, while the secondary endpoint was the difference in time below range<54 mg/dL; TBR<54, between the SU (n=63) and non-SU (n=60) groups. The standard deviation, percentage coefficient of variation (%CV), and maximum glucose level were higher in the SU group than in the non-SU group, and TBR<54 was longer in the high-dose SU patients. SU treatment was identified as a significant factor that affected %CV (beta: 2.678, p=0.034). High-dose SU use contributed to prolonged TBR<54 (beta: 0.487, p=0.028). Our study identified enlarged glycemic variability in sulfonylurea-treated well-controlled T2DM patients and high-dose SU use was associated with TBR<54. The results highlight the need for careful adjustment of the SU dose, irrespective of glycated hemoglobin level or TIR value.