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Monitoring of metabolic control in patients with non‐insulin‐dependent diabetes mellitus on oral hypoglycaemic agents: value of evening blood glucose determination

Monitoring of metabolic control in patients with non‐insulin‐dependent (Type 2) diabetes (NIDDM) is usually based upon blood glucose assay in the morning (after an overnight fast) and in the postprandial state (breakfast or lunch). However, this schedule does not seek low blood glucose values, especially in the evening. We have conducted a prospective study of laboratory blood glucose profiles (8 am, 9.30 am after a 35 g carbohydrate breakfast and in the evening between 5 and 7 pm). We have included 58 consecutive NIDDM patients regularly followed in our clinic (39 men, age 60 ± 11.5 years, diabetes duration 8.6 ± 6.5 years, BMI 25.5 ± 3 kg m−2 ), treated with the sulphonylurea gliclazide, alone (40–320 mg 24 h−1 , mean 170 ± 110 mg) (group 1, n = 32) or in combination with metformin (1000–3000 mg 24 h−1 , 2400 ± 620 mg) (group 2, n = 26). All patients were stable, with no change in dosage for at least 3 months. Mean glycaemic control was good (group 1 HbA1c : 6.5 ± 1.1 %, group 2: 6.9 ± 0.7 %). Evening blood glucose values were the lowest of the day in 26 patients of group 1 (81.3 %) and in 22 of group 2 (84.6 %). Mean evening blood glucose levels were lower (p = 0.001) than 8 am values (group 1: 5.8 ± 1.4 vs 6.1 ± 1.6 mmol l−1 , group 2: 6.5 ± 1.8 vs 6.9 ± 1.9) and than 9.30 am values (group 1: 7.6 ± 1.5, group 2: 12.3 ± 2.8). No blood glucose values in the hypoglycaemic range were observed. HbA1c was strongly correlated (p = 0.002 to 0.0001) in the whole group with 8 am (r = 0.39), 9.30 am (r = 0.56), and evening blood glucose values (r = 0.42). These results indicate that, in patients treated with the sulphonylurea gliclazide, alone or in combination with metformin, the lowest blood glucose values occur in the evening more frequently (4/5) than in the morning. Therefore, evening blood glucose determination should be performed systematically in the course of the metabolic evaluation of NIDDM patients on oral hypoglycaemic agents. © 1997 John Wiley & Sons, Ltd.