View Full Version : [Endocrinology and DM] Dawn Phenomenon Affects Half of Type 2 Diabetes Patients

Sun 2nd March '14, 12:58pm
From http://www.medscape.com/viewarticle/814001?src=wnl_edit_medn_wir&uac=180112PN&spon=34

The so-called "dawn phenomenon" has a significant impact on many of those with type 2 diabetes and is already present in some patients treated only with diet alone, new research shows. In addition, this effect is not blunted by oral hypoglycemic agents, the study by Louis Monnier, MD, from University Montpellier, France, and colleagues reveals.

The dawn phenomenon refers to a spontaneous rise in blood glucose that occurs at the end of the night in patients with both type 1 and type 2 diabetes; this does not occur in individuals without diabetes, because endogenously produced insulin prevents this.

The findings indicate that in selected type 2 diabetes patients, specifically those with HbA 1c approaching 7% who are demonstrating evidence of the dawn phenomenon, insulin use should be considered earlier than it is traditionally, because insulin can eliminate this effect, said Geremia B Bolli, MD, from the University of Perugia, Italy.

"We have defined the frequency of the dawn phenomenon in type 2 diabetes, which in the present paper occurs in around 50% of patients, and this definition is more accurate than previous ones due to our use of continuous glucose monitoring [CGM] systems," Dr. Monnier told Medscape Medical News.

In addition, he and his colleagues quantify the effect of this phenomenon, showing that the mean impact on HbA 1c was around a 0.4% rise. "This may seem small," said Dr. Monnier, "but when one considers that treatment with, for example, [dipeptidyl peptidase-4] DPP-4 inhibitors [gliptins], results in a mean drop in HbA 1c of only around 0.7% to 0.8% [as well as] that a drop of 1.0% in HbA 1c can reduce macrovascular complications by 40% and microvascular ones by 37%," then one can gauge the significance.

Dr. Monnier agrees with Dr. Bolli that the new findings indicate that insulin use should be considered earlier for type 2 diabetes patients showing evidence of the dawn phenomenon. "We are unable to control the dawn phenomenon with our current armamentarium of oral hypoglycemic agents, even though metformin is probably the one that has the highest potency for reducing [it]. My position is that insulin should be considered for the treatment of type 2 diabetes as soon as the HbA 1c becomes greater than 7% when patients are already treated with maximal tolerated doses of oral agents," he told Medscape Medical News.

Dr. Monnier and colleagues' study is published online October 29 in Diabetes Care.