Evaluation of Glycemic Variability in Well-Controlled Type 2 Diabetes Mellitus

Abstract

Aims: It is necessary to evaluate glucose variability and postprandial hyperglycemia in patients with well-controlled type 2 diabetes mellitus because of the limitations associated with hemoglobin A1c (HbA1c) measurements. We evaluated parameters reflecting postprandial hyperglycemia and glycemic variability in patients with optimal HbA1c. Patients and Methods: Thirty-nine patients with HbA1c levels below 7% were recruited to the study. A continuous glucose monitoring system (CGMS) was applied for two 72-h periods. 1,5-Anhydroglucitol (1,5-AG) and fructosamine (FA) were measured as parameters for postprandial hyperglycemia and glucose variability. Using CGMS data, the following postprandial hyperglycemia parameters were calculated: mean postprandial maximum glucose (MPMG) and area under the curve for glucose above 180 mg/dL (AUC-180). To measure glycemic variability, we calculated mean amplitude of glucose excursion (MAGE) using a classical (MAGE c ) and new method (MAGE group of sign [MAGE gos ]). Results: The baseline HbA1c level was 6.3 -0.3%. The mean MPMG was 10.34 -1.84 mmol/L, and the mean AUC-180 was 0.17 -0.23 mmol/L/day. The mean MAGE gos was 3.27 -1.29 mmol/L, and MAGE c was 4.30 -1.43 mmol/L, indicating glycemic variability in our patients. The mean levels of 1,5-AG and FA were 16.7 -7.4 lg/mL and 273.0 -22.5 lmol/L, respectively. In a correlation analysis, FA was significantly correlated with MPMG, AUC-180, MAGE gos , and MAGE c . In contrast, 1,5-AG was only correlated with AUC-180. Conclusions: This study demonstrated postprandial hyperglycemia and glycemic variability in subjects with well-controlled diabetes. FA may reflect postprandial hyperglycemia and glycemic variability, but 1,5-AG may be of limited value for assessing glucose variability in patients with well-controlled type 2 diabetes mellitus.

Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes

“…GV increases progressively as people develop impaired fasting glucose, impaired glucose tolerance, and finally overt type 2 diabetes. [58][59][60][61] After development of type 2 diabetes, with progressive loss of beta cell function, there is usually periodic advancement in the intensity of therapy, from mono-, to dual-, to triple-therapy, and finally to injectables (insulin, GLP-1RA agents, or both). Accordingly, the form of therapy can be used as a surrogate for the duration and severity of diabetes.…”

Increased Glycemic Variability at the Onset and During Progression of Type 2 Diabetes—Commentary

“…Chon et al 3 : Assessing Possible Relationships of GV to Fructosamine and 1,5-AG Chon et al 3 examined several indices of GV in a small group of patients with T2DM who were extremely well controlled (glycosylated hemoglobin level < 7%). They were hoping to find a correlation of these indices with fructosamine, a biochemical marker of glycemic control, and with 1-5 AG, which is presumed to be a biochemical marker of GV.…”

“…2 A third article examines the relationship of GV observed using CGM to serum levels of fructosamine and 1,5-anhydroglucitol (1,5-AG) in subjects with very well-controlled diabetes. 3 We shall discuss some of the principal findings, briefly consider pathophysiological mechanisms that might be involved, and discuss some of the methodological issues encountered in the measurement of GV using CGM.…”

Biochemical Alterations in Zinc Deficient Sheep Associated by Hyperlactatemia

“…So, fructosamine is a medium term indicator of 2-3 weeks of hyperglycemia (Chon et al, 2013). Fructosamine is also formed when the carbonyl group of glucose reacts with an amino group of a serum albumin, as the double bond to oxygen moves from the end carbon atom to the next carbon atom with the production of water (Lee et al, 2013a).…”