医学
血糖性
2型糖尿病
内科学
糖尿病
就寝时间
持续气道正压
随机对照试验
血压
1型糖尿病
气道正压
物理疗法
胰岛素
内分泌学
阻塞性睡眠呼吸暂停
作者
R. Nisha Aurora,Mary R. Rooney,Sheng Wang,Elizabeth Selvin,Naresh M. Punjabi
出处
期刊:Chest
[Elsevier]
日期:2023-10-01
卷期号:164 (4): 1057-1067
被引量:5
标识
DOI:10.1016/j.chest.2023.04.017
摘要
Background Glycemic variability is associated with increased risk for cardiovascular disease in patients with type 2 diabetes independent of glycosylated hemoglobin A1c (HbA1c) levels. Given the conflicting evidence on the effect of positive airway pressure (PAP) therapy for OSA on HbA1c, elucidating its effect on glycemic variability has value. Research Question Does the use of PAP therapy for OSA improve glycemic variability in patients with type 2 diabetes? Study Design and Methods A randomized controlled trial was conducted in 184 patients with type 2 diabetes and moderate-to-severe OSA. Participants received either 3 months of PAP therapy with lifestyle counseling or lifestyle counseling alone. End points included the SD of glucose levels along with other metrics derived from continuous glucose monitoring and self-monitoring of blood glucose. Results No differences were noted in either primary or secondary continuous glucose monitoring end points between the two groups. Average use of PAP therapy was 5.4 h/night (SD, 1.6). Exploratory analyses by sex showed significant differences in the primary and secondary outcomes. In women, PAP therapy was associated with improvement in the SD of glucose levels, with a mean difference in change between intervention and control groups of 3.5 mg/dL (P = .02). PAP therapy was also associated with lower postdinner and bedtime glucose levels: 20.1 mg/dL (P < .01) and 34.6 mg/dL (P < .01), respectively. Interpretation PAP therapy did not improve glycemic control or variability in patients with moderate-to-severe OSA and type 2 diabetes. Exploratory analyses suggested that PAP therapy may improve glucose variability in women. Postdinner and bedtime glucose levels were higher in those who did not receive PAP therapy. Trial Registration ClinicalTrials.gov; No.: NCT02454153; URL: www.clinicaltrials.gov Glycemic variability is associated with increased risk for cardiovascular disease in patients with type 2 diabetes independent of glycosylated hemoglobin A1c (HbA1c) levels. Given the conflicting evidence on the effect of positive airway pressure (PAP) therapy for OSA on HbA1c, elucidating its effect on glycemic variability has value. Does the use of PAP therapy for OSA improve glycemic variability in patients with type 2 diabetes? A randomized controlled trial was conducted in 184 patients with type 2 diabetes and moderate-to-severe OSA. Participants received either 3 months of PAP therapy with lifestyle counseling or lifestyle counseling alone. End points included the SD of glucose levels along with other metrics derived from continuous glucose monitoring and self-monitoring of blood glucose. No differences were noted in either primary or secondary continuous glucose monitoring end points between the two groups. Average use of PAP therapy was 5.4 h/night (SD, 1.6). Exploratory analyses by sex showed significant differences in the primary and secondary outcomes. In women, PAP therapy was associated with improvement in the SD of glucose levels, with a mean difference in change between intervention and control groups of 3.5 mg/dL (P = .02). PAP therapy was also associated with lower postdinner and bedtime glucose levels: 20.1 mg/dL (P < .01) and 34.6 mg/dL (P < .01), respectively. PAP therapy did not improve glycemic control or variability in patients with moderate-to-severe OSA and type 2 diabetes. Exploratory analyses suggested that PAP therapy may improve glucose variability in women. Postdinner and bedtime glucose levels were higher in those who did not receive PAP therapy. ClinicalTrials.gov; No.: NCT02454153; URL: www.clinicaltrials.gov
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