Glucose Variability; Does It Matter?

Abstract

Overall lowering of glucose is of pivotal importance in the treatment of diabetes, with proven beneficial effects on microvascular and macrovascular outcomes. Still, patients with similar glycosylated hemoglobin levels and mean glucose values can have markedly different daily glucose excursions. The role of this glucose variability in pathophysiological pathways is the subject of debate. It is strongly related to oxidative stress in in vitro, animal, and human studies in an experimental setting. However, in real-life human studies including type 1 and type 2 diabetes patients, there is neither a reproducible relation with oxidative stress nor a correlation between short-term glucose variability and retinopathy, nephropathy, or neuropathy. On the other hand, there is some evidence that long-term glycemic variability might be related to microvascular complications in type 1 and type 2 diabetes. Regarding mortality, a convincing relationship with short-term glucose variability has only been demonstrated in nondiabetic, critically ill patients. Also, glucose variability may have a role in the prediction of severe hypoglycemia. In this review, we first provide an overview of the various methods to measure glucose variability. Second, we review current literature regarding glucose variability and its relation to oxidative stress, long-term diabetic complications, and hypoglycemia. Finally, we make recommendations on whether and how to target glucose variability, concluding that at present we lack both the compelling evidence and the means to target glucose variability separately from all efforts to lower mean glucose while avoiding hypoglycemia.

Biology of Human Aging and Recent Nutrition Therapy

“…Similar results were found on 7 times or 20 times of sampling per day [45,46]. It also revealed similar results compared with the continuous glucose monitoring (CGM) [47,48].…”

Correlation between parameters of self-monitoring of blood glucose and the perception of health-related quality of life in patients with type 1 diabetes mellitus

“…Our main finding was that MGL, but not HbA 1c levels or number of hypoglycemic episodes, was the only indicator independently associated with a worse perception of HRQoL. Different studies have already described an association between higher levels of HbA 1c and a substantially lower HRQoL (13)(14)(15)(16)(17), with higher scores on the PAID (18). Our study did not find an independent correlation between HRQoL and HbA 1c levels.…”

Blood Glucose Self-Monitoring Patterns in Mexican Americans: Further Lessons from the Starr County Border Health Initiative

“…This is disappointing because (1) there is a dearth of studies that have involved analyses of glucose variability, particularly in such populations as Mexican Americans residing in impoverished rural communities, (2) glucose variability has been associated with risk of microvascular complications and increased carotid intima media thickness, (3) increased glucose variability is a strong predictor of hypoglycemia and poor glucose control, and (4) wide variability and poor control can be masked by relying on A1C values to assess management status. [20][21][22][23] SMBG is not a ''stand-alone'' diabetes therapeutic intervention. It may be difficult for persons with T2DM to see its value when it is one of several behavioral strategies recommended for daily diabetes self-management.…”