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The dawn phenomenon revisited: implications for diabetes therapy
Mary F Carroll1, David S Schade
1Endocrinology and Metabolism Clinic, Eastern New Mexico Medical Center, Roswell, New Mexico, USA.
Summary
The dawn phenomenon, characterized by early morning hyperglycemia in diabetes, affects over half of patients with type 1 and type 2 diabetes. Growth hormone likely impairs insulin sensitivity, necessitating personalized management strategies like continuous insulin infusion.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- The dawn phenomenon is a common occurrence in diabetes mellitus.
- It is characterized by unexplained hyperglycemia during early morning hours.
- Understanding its prevalence and pathogenesis is crucial for effective diabetes management.
Purpose of the Study:
- To summarize current data on the dawn phenomenon.
- To define its magnitude, prevalence, variability, and pathogenesis.
- To suggest management options for patients with diabetes mellitus.
Main Methods:
- Literature review and clinical experience.
- Proposed a quantitative definition for the dawn phenomenon.
- Discussed potential pathogenic mechanisms and management strategies.
Main Results:
- Dawn phenomenon defined as a blood glucose increase >10 mg/dL or insulin need increase >20% from overnight nadir.
- Affects approximately 54% of type 1 and 55% of type 2 diabetes patients.
- Growth hormone-mediated insulin resistance is the likely cause, though exact pathways are unknown.
Conclusions:
- Management of fasting hyperglycemia must consider the dawn phenomenon's variability.
- Continuous subcutaneous insulin infusion can prevent early morning hyperglycemia in select patients.
- Adjusting bedtime hypoglycemic agents may cause nocturnal hypoglycemia.