Continuous Glucose Monitoring Reveals Glycemic Profile in Adrenal Insufficiency Patients on Glucocorticoid Replacement.

OBJECTIVE

Hypoglycemia is common in the patients with adrenal insufficiency (AI), who require lifelong glucocorticoid replacement therapy. However, whether this therapy restores physiological glycemic fluctuations in the patients with AI remains unclear. This study aimed to characterize glucose fluctuation pattern in the patients with AI using continuous glucose monitoring (CGM).

METHODS

Twenty-seven patients with AI on stable doses of glucocorticoid were consecutively enrolled. Fifty-four age-, sex-, and BMI-matched normal controls (NC) were selected from a healthy volunteer database at a 2:1 ratio. CGM was conducted with a blinded method for 14 days. Glucocorticoid regimen and adverse events during CGM were documented.

RESULTS

The AI group had a mean age of 59.53±8.51 years (15 males). Compared with NC, the patients with AI exhibited increased time below range (TBR, glucose <3.9 and <3.0 mmol/L) and decreased time in range (TIR, glucose within 3.9-7.8 mmol/L). Time above range (TAR, glucose ≥7.8 mmol/L) were elevated during the lunch and dinner periods, and glucose fluctuation parameters were also increased. CGM-detected hypoglycemia was observed in all patients (27/27, 100%) versus 46/54 (85.2%) controls (p = 0.047). The patients receiving once-daily glucocorticoid had higher lunchtime TAR than those on twice-daily dosing. Hydrocortisone-treated patients showed higher breakfast and lunchtime TAR compared with prednisone users. Patients with immune checkpoint inhibitors (ICIs) induced AI had higher glucose levels and fluctuation parameters during breakfast and dinner periods than those with other etiologies.

CONCLUSIONS

Patients with AI receiving glucocorticoid replacement experience more frequent CGM-recorded asymptomatic hypoglycemia and greater glucose variability. CGM may provide valuable insights for optimizing glucocorticoid administration strategies in AI.