Glucose variability measures and their effect on mortality: a systematic review

Abstract

ObjectiveTo systematically review the medical literature on the association between glucose variability measures and mortality in critically ill patients.MethodsStudies assessing the association between a measure of glucose variability and mortality that reported original data from a clinical trial or observational study on critically ill adult patients were searched in Ovid MEDLINE® and Ovid EMBASE®. Data on patient populations, study designs, glucose regulations, statistical approaches, outcome measures, and glucose variability indicators (their definition and applicability) were extracted.ResultTwelve studies met the inclusion criteria; 13 different indicators were used to measure glucose variability. Standard deviation and the presence of both hypo- and hyperglycemia were the most common indicators. All studies reported a statistically significant association between mortality and at least one glucose variability indicator. In four studies both blood glucose levels and severity of illness were considered as confounders, but only one of them checked model assumptions to assert inference validity.ConclusionsGlucose variability has been quantified in many different ways, and in each study at least one of them appeared to be associated with mortality. Because of methodological limitations and the possibility of reporting bias, it is still unsettled whether and in which quantification this association is independent of other confounders. Future research will benefit from using an indicator reference subset for glucose variability, metrics that are linked more directly to negative physiological effects, more methodological rigor, and/or better reporting.

Visit‐to‐Visit Variability of Fasting Plasma Glucose and the Risk of Cardiovascular Disease and All‐Cause Mortality in the General Population

“…A systematic review reported that there were 13 different indicators to measure glucose variability 10. SD was one of the most common indicators.…”

Glucose Variability and Mortality in Patients Hospitalized With Acute Myocardial Infarction

“…It is also possible that our dataset contains more detailed information on potential confounders. For example, only half of the prior studies included a severity-of-illness indicator in their models, 13,[15][16][17][18]31 and few contained detailed data on comorbidities. In addition, there is no single established measure of GV, and prior studies have tested and reported on a variety of such measures.…”

“…As suggested by a recent systematic review, reporting bias may result in GV measures found to be more strongly associated with outcomes to be preferentially reported and published. 31 Another possibility is that the intensity of BG monitoring (and therefore the amount of data that is used to measure GV) may differ between critically ill patients in medical and surgical intensive care units and those with AMI. BG monitoring tends to be more frequent in medical/surgical intensive care units versus coronary care units.…”

Improvement of β-cell function ameliorated glycemic variability in patients with newly diagnosed type 2 diabetes after short-term continuous subcutaneous insulin infusion or in combination with sitagliptin treatment: a randomized control trial

“…The dosages were titrated every day in order to attain euglycemia within 5-7 days. During intervention patients were instructed to continue diet and physical exercise: a balindependent cohorts, which have been meta-analyzed [4]. Of note, the strong relationship between GV and diabetic complications [5][6][7][8], including cardiovascular complications [8,9], have been demonstrated, which may support the concept that GV can confer additional risk to the development of complications over that predicted by the mean glucose value alone [1].…”