Association between the extent of urinary albumin excretion and glycaemic variability indices measured by continuous glucose monitoring

Jin, Sang‐Man; Kim, T. H.; Oh, Seung-Hoon; Baek, Jin Yang; Joung, Ji Young; Park, S. M.; Cho, Y. Y.; Sohn, Seo Young; Hur, Kyu Yeon; Lee, M. S.; Kim, J. H.

doi:10.1111/dme.12607

Cited by 31 publications

(21 citation statements)

References 30 publications

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“…Besides higher HbA1c levels, increased glycemic variability in T1D patients is associated with a higher risk of retinopathy, nephropathy, and peripheral neuropathy. [29][30][31][32] Recently, this was also demonstrated in T1D adolescents with a median age of 15.9 years. 33 Time between insulin administration and finishing consumption of the test meal was significantly increased compared to the standard effect of insulin aspart is noticeable after 10 to 20 minutes and the estimated total insulin action is 3 to 5 hours.…”

Section: Discussionmentioning

confidence: 73%

“…Fluctuations in glucose levels appear to be considerably relevant with regard to long‐term diabetic complications. Besides higher HbA1c levels, increased glycemic variability in T1D patients is associated with a higher risk of retinopathy, nephropathy, and peripheral neuropathy . Recently, this was also demonstrated in T1D adolescents with a median age of 15.9 years …”

Section: Discussionmentioning

confidence: 81%

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The influence of food order on postprandial glucose levels in children with type 1 diabetes

et al. 2018

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 81%

The influence of food order on postprandial glucose levels in children with type 1 diabetes

et al. 2018

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“…[4][5][6] The severity of hyperglycemia and glycemic variability are shown to contribute to the pathogenesis of complications Department of Endocrinology, Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India such as retinopathy, peripheral neuropathy, urinary albumin excretion, cardiovascular events, and overall mortality; but the HbA1c measurement reflects only a piece of these important variables. [7][8][9][10][11][12][13][14] Numerous studies also support the association of long-term glycemic variability with an enhanced risk of micro and macrovascular complications, independent of HbA1c levels. [14][15][16] Hence in such cases, appropriate treatment decisions would be a challenge for the clinicians.…”

Section: Glucosementioning

confidence: 94%

Role of ambulatory glucose profile in identifying and managing a patient with disparity between FPG, PPG and HbAlc levels: a case report

Saboo

2020

Int J Res Med Sci

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This case report describes the management of a patient with mismatch/disparity between his Fasting Plasma Glucose (FPG)/ Postprandial Glucose (PPG) levels with that of Glycosylated Haemoglobin (HbA1c) levels. This 43-year-old male patient with Type 2 Diabetes Mellitus (T2DM) was presented with increased urination and tiredness, especially in the evening hours, along with a tingling sensation in bilateral feet on and off, with leg pain since past 4 months. The patient was obese with a family history of cardiovascular disease. In this patient, SGLT2 inhibitors were found to be effective in addressing glycaemic variability without triggering hypoglycaemic risk. Continuous glucose monitoring system aided in understanding the blood glucose fluctuations caused by the diet. This case study indicated that careful evaluation and appropriate management using Ambulatory Glucose profile would aid in preventing complications in such patients and improve the overall clinical outcomes.

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“…There is observational evidence that postprandial and/or post‐load blood glucose is associated with all‐cause mortality , and more limited evidence that it is associated with cardiovascular events . On this basis, it has been suggested that glucose variability may play a role in the pathogenesis of cardiovascular complications in Type 2 diabetes: for example, in a cross‐sectional study, sd of glucose variability derived from continuous glucose monitoring (CGM) (see below) was associated with the presence of microalbuminuria (although this finding was no longer significant after adjustment for mean glucose) .…”

Section: Insights From Type 2 Diabetesmentioning

confidence: 99%

How tightly controlled do fluctuations in blood glucose levels need to be to reduce the risk of developing complications in people with Type 1 diabetes?

2019

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In 2011, the James Lind Alliance published a ‘top 10’ list of priorities for Type 1 diabetes research based on a structured consultation process. Whether reducing fluctuations in blood glucose can prevent long‐term microvascular and macrovascular complications was one of these. In this narrative review, 8 years on, we have assessed the updated evidence for the assertion that increased glucose variability plays an independent and clinically important role in the complications of Type 1 diabetes, over and above mean blood glucose and the effects of hypoglycaemia: the ‘glucose variability hypothesis’. Although studies in cultured cells and ex vivo vessels have been suggestive, most studies in Type 1 diabetes have been small and/or cross‐sectional, and based on ‘finger‐prick’ glucose measurements that capture glucose variability only in waking hours and are affected by missing data. A recent analysis of the Diabetes Control and Complications Trial that formally imputed missing data found no independent effect of short‐term glucose variability on long‐term complications. Few other high‐quality longitudinal studies have directly addressed the glucose variability hypothesis in Type 1 diabetes. We conclude that there is little substantial evidence to date to support this hypothesis in Type 1 diabetes, although increasing use of continuous glucose monitoring provides an opportunity to test it more definitively. In the meantime, we recommend that control of glycaemia in Type 1 diabetes should continue to focus on the sustained achievement of target HbA1c and avoidance of hypoglycaemia.

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Association between the extent of urinary albumin excretion and glycaemic variability indices measured by continuous glucose monitoring

Cited by 31 publications

References 30 publications

The influence of food order on postprandial glucose levels in children with type 1 diabetes

The influence of food order on postprandial glucose levels in children with type 1 diabetes

Role of ambulatory glucose profile in identifying and managing a patient with disparity between FPG, PPG and HbAlc levels: a case report

How tightly controlled do fluctuations in blood glucose levels need to be to reduce the risk of developing complications in people with Type 1 diabetes?

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