Réduire de manière concomitante l'exposition chronique au glucose et les fluctuations glycémiques dans le diabète de type 2 : Est-ce possible ?

Reducing the chronic exposure to glucose (the « ambient hyperglycemia ») is one of the main objectives in the management of type 2 diabetes (T2D). Another goal, which is far from being of ancillary importance, is to limit the intra-individual glucose variability in order to reduce the risk for hypoglycemic episodes. One of the major issues is to know as to how these objectives can or not be concomitantly achieved with our current therapeutic armamentarium. This clinical problem is illustrated by the case report of an obese T2D patient who remains inadequately controlled despite a treatment with high doses of a once daily injection of basal insulin. This observation offers the opportunity to discuss the different therapeutic options that are aimed at concomitantly reducing the ambient hyperglycemia and acute glucose fluctuations. In the present case, the preferential choice seems to be oriented towards an add-on therapy with a GLP-1 receptor agonist, which globally and ideally permits reducing the HbA1c, body weight, glycemic variability, and the risk for hypoglycemia. This clinical case led us to discuss the choice between long and short-acting GLP-1 receptor agonists according to whether they have a predominant impact on basal hyperglycemia or postprandial glucose excursions, respectively.