The dawn phenomenon in type 2 diabetes: its association with glucose excursions and changes after oral glucose-lowering drugs

Jun-Sing Wang; I-Te Lee; Wen-Jane Lee; Shi-Dou Lin; Shih-Li Su; Shih-Te Tu; Shih-Yi Lin; Wayne Huey-Herng Sheu

doi:10.1177/20406223211033674

The dawn phenomenon in type 2 diabetes: its association with glucose excursions and changes after oral glucose-lowering drugs

Ther Adv Chronic Dis. 2021 Aug 10:12:20406223211033674. doi: 10.1177/20406223211033674. eCollection 2021.

Authors

Jun-Sing Wang¹, I-Te Lee², Wen-Jane Lee³, Shi-Dou Lin⁴, Shih-Li Su⁴, Shih-Te Tu⁴, Shih-Yi Lin⁵, Wayne Huey-Herng Sheu⁶

Affiliations

¹ Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University, Taichung Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung.
² Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung.
³ Department of Medical Research, Taichung Veterans General Hospital, Taichung.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang-Hua Christian Hospital, Chang-Hua.
⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei.
⁶ Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei Institute of Medical Technology, College of Life Science, National Chung Hsing University, Taichung.

Abstract

Background: We investigated the association between glucose excursions and the dawn phenomenon, and the effects of oral-glucose lowering drugs on the dawn phenomenon in patients with type 2 diabetes (T2D).

Methods: We conducted a post hoc analysis using data from a previous randomized trial. Patients with T2D on metformin monotherapy were randomized to receive add-on acarbose or glibenclamide for 16 weeks. Ambulatory continuous glucose monitoring (CGM) was conducted before randomization and at the end of the study. Using the CGM data, we assessed glucose excursions as indicated by mean amplitude of glycemic excursions (MAGE). The magnitude of the dawn phenomenon was calculated as the difference between the nocturnal nadir (0:00 to 6:00 a.m.) and prebreakfast glucose level.

Results: A total of 50 patients with T2D [mean age 53.5 ± 8.2 years, mean glycated hemoglobin (HbA1c) 8.4 ± 1.2%] were analyzed. There was an independent association between MAGE and the dawn phenomenon [β coefficient 0.199, 95% confidence interval (CI) 0.074-0.325, p = 0.003]. HbA1c improved significantly after treatment with acarbose or glibenclamide. However, only treatment with acarbose significantly improved glucose excursions. The dawn phenomenon decreased significantly only in patients treated with acarbose (from 35.9 ± 15.7-28.3 ± 16.5 mg/dl, p = 0.037), but not in those treated with glibenclamide (from 35.9 ± 20.6-34.6 ± 17.0 mg/dl, p = 0.776).

Conclusion: Glucose excursions were independently associated with the dawn phenomenon in patients with T2D on metformin monotherapy. Both glucose excursions and the dawn phenomenon improved after treatment with acarbose, but not after treatment with glibenclamide.

Keywords: continuous glucose monitoring; dawn phenomenon; glucose excursions; type 2 diabetes.