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Dawn phenomenon and Somogyi effect in IDDM.

J M Stephenson1, G Schernthaner

  • 1Department of Medicine II, University of Vienna, Austria.

Diabetes Care
|April 1, 1989
PubMed
Summary

A rise in blood glucose (BG) between 3 AM and 6 AM, known as the dawn phenomenon, impacts daytime glucose control in insulin-dependent diabetes mellitus (IDDM) patients. Basal-bolus insulin therapy (BBIT) reduced this rise compared to conventional therapy (CT).

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Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Diabetes Mellitus Research

Background:

  • The dawn phenomenon, characterized by a rise in blood glucose (BG) between 3 AM and 6 AM, is a recognized challenge in managing diabetes.
  • Understanding factors influencing this phenomenon is crucial for optimizing glycemic control in patients with insulin-dependent diabetes mellitus (IDDM).

Purpose of the Study:

  • To investigate the clinical relevance of the dawn phenomenon in IDDM patients.
  • To assess the impact of posthypoglycemic hyperglycemia as a potential cause of the dawn rise.
  • To compare the magnitude of the dawn rise between conventional insulin therapy (CT) and basal-bolus insulin therapy (BBIT).

Main Methods:

  • Analysis of 231 24-hour BG profiles from 97 IDDM patients.
  • BG measurements were taken every 3 hours.
  • Patients were treated sequentially with CT and BBIT.

Main Results:

  • A dawn rise in BG occurred in 68% of profiles.
  • The mean dawn rise was significantly lower during BBIT (48 ± 35 mg/dl) compared to CT (62 ± 43 mg/dl).
  • A dawn rise greater than 50 mg/dl correlated with higher subsequent mean daytime BG levels (r=0.38, P<0.0001).
  • Nocturnal hypoglycemia (BG < 60 mg/dl) occurred in 25% of profiles.

Conclusions:

  • The dawn phenomenon significantly impacts daytime glycemic control in IDDM.
  • BBIT is more effective than CT in mitigating the dawn rise.
  • Posthypoglycemic hyperglycemia may contribute to the dawn rise, warranting further investigation.

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