Short-term Glycemic Variability and Its Association With Macrovascular and Microvascular Complications in Patients With Diabetes

Abstract

The introduction of continuous glucose monitoring inaugurated a new era in clinical practice by shifting the characterization of glycemic control from HbA1c to novel metrics. The one that gained widespread attention over the past decades was glycemic variability (GV), which typically refers to peaks and nadirs of blood glucose measured over a given time interval. GV can be dichotomized into two main categories: short-term and long-term. Short-term GV reflects within-day and between-day glycemic oscillations, and its contribution to diabetic complications remains an enigma. In this review, we summarize the available data about short-term GV and its possible association with both microvascular and macrovascular complications, evaluating different pathogenic mechanisms and demonstrating nonpharmaceutical, as well as pharmaceutical, therapeutic interventions.

Association between area under the C‐peptide curve during an oral glucose tolerance test and diabetic retinopathy in type 2 diabetes patients

“…Type 2 diabetes patients with or without DR were eligible for this study. The exclusion criteria are as follows: (1) positive autoimmune antibodies to diabetes or other specific types of diabetes; (2) hospitalized patients mainly diagnosed with acute diabetic complications, such as diabetic ketoacidosis and diabetic hypertonic coma; (3) active or chronic inflammation, active infection or autoimmune disease; (4) hematological diseases, recent blood transfusion before enrollment or malignant tumors; (5) acute or chronic kidney/liver disease; (6) other eye diseases affecting the diagnosis of DR were excluded, such as macular degeneration, retinal vein obstruction and glaucoma; and (7) incomplete basic information, such as medication history and past disease history. Based on inclusion and exclusion criteria, 969 diabetes patients were enrolled from January 2016 to August 2022 and assigned to either the DR group (n = 469) or type 2 diabetes group (n = 500; Figure 1).…”

“…Glycemic variability and poorer glycemic control caused by b-cell dysfunction might lead to an increased risk of diabetic complications 5 . Large glycemic variability is positively associated with microvascular and macrovascular complications, and mortality 6,7 . Intensive blood glucose control can restore part of pancreatic b-cells.…”

Glycated hemoglobin variability and the risk of cardiovascular events in patients with prediabetes and type 2 diabetes mellitus: A post‐hoc analysis of a prospective and multicenter study

“…There are two categories of glycemic variability: (i) short-term glycemic variability, which is measured by a continuous glucose monitoring system, and represents within-day and between-day glycemic variability; and (ii) long-term glycemic variability, which is determined by visit-to-visit HbA1c, serial fasting or serial postprandial measurements. Both types of glycemic variability have been reported to be associated with MACE [4][5][6][7] .…”

“…Additionally, each 1% reduction of HbA1c is related to a 21% reduction in the incidence of all complications related to diabetes 3 . Apart from high HbA1c, glycemic variability also confers a risk for diabetes‐related complications 4 . There are two categories of glycemic variability: (i) short‐term glycemic variability, which is measured by a continuous glucose monitoring system, and represents within‐day and between‐day glycemic variability; and (ii) long‐term glycemic variability, which is determined by visit‐to‐visit HbA1c, serial fasting or serial postprandial measurements.…”

Three components of glucose dynamics – value, variability, and autocorrelation – are independently associated with coronary plaque vulnerability

“…Blood glucose levels are among the readily obtained predictors of the complications. 5 The disrupted conditions of glucose dynamics seen in impaired glucose tolerance (IGT) and T2DM are partly characterized by high concentrations of blood glucose levels. 6 High concentrations of blood glucose levels have been defined as having high hemoglobin A1c (HbA1c) levels, fasting blood glucose (FBG) levels, and plasma glucose concentration at 120 min during the oral glucose tolerance test (OGTT) (PG120).…”