Beyond HbA1c: Comparing Glycemic Variability and Glycemic Indices in Predicting Hypoglycemia in Type 1 and Type 2 Diabetes

Abstract

Assessment of glycemia should go beyond HbA1c and incorporate measures of GV and glycemic indices. %CV in type 1 diabetes and LBGI or a combination of HbA1c and %CV in type 2 diabetes discriminated hypoglycemia well. In defining hypoglycemia risk using GV and glycemic indices, diabetes subtypes and data source (CGM vs. SMBG) must be considered.

Assessing hypoglycemia frequency using flash glucose monitoring in older Japanese patients with type 2 diabetes receiving oral hypoglycemic agents

“…According to previous reports, studies that analyzed blood glucose variability by self‐monitoring of blood glucose and CGM also point out that CV, SD, daily low blood glucose level and mean blood glucose level are better predictors of hypoglycemia than HbA1c Furthermore, the CV derived by FGM and the frequency of hypoglycemia showed a positive significant correlation, the large blood glucose fluctuation increased the risk of hypoglycemia in the present study. However, in actual daily outpatients, it is difficult to measure CV, SD, daily minimum blood glucose level and mean blood glucose level using CGM.…”

The relationship between glycaemic variability and cardiovascular autonomic dysfunction in patients with type 1 diabetes: A systematic review

“…A combination of the most relevant indices is necessary to effectively describe GV. For example, COV is more valid than SD in reflecting overall GV 74 and more sensitive in predicting hypoglycaemia 9,74 , while the MAGE index mainly reflects mealtime-related GV 7 .…”

“…All rights reserved. account the risk for hypo-and hyperglycaemic events 9 . Other metrics have also been proposed but are rarely used 7,[10][11][12][13][14] .…”

Metabolic surgery for the treatment of type 2 diabetes in patients with BMI lower than 35 kg/m2: Why caution is still needed

“…The adoption of HbA1c values as an endpoint is also imperfect, since the values can be falsely reduced in patients with iron deficiency, which is a common complication of bariatric surgery, 28 added to the fact that HbA1c is not a good marker of glycemic variability. 29 Considering that some studies have observed higher glycemic variability amongst bariatric patients despite a normal HbA1c, this is a topic that undoubtedly warrants more research. [30][31][32] We should also bear in mind that more important than the glycemic control are the long-term (macrovascular and microvascular) outcomes in diabetes, which will also be discussed.…”

“…In this context, a more logical endpoint would be HbA1c values or fixed HbA1c values with or without medications. The adoption of HbA1c values as an endpoint is also imperfect, since the values can be falsely reduced in patients with iron deficiency, which is a common complication of bariatric surgery, added to the fact that HbA1c is not a good marker of glycemic variability . Considering that some studies have observed higher glycemic variability amongst bariatric patients despite a normal HbA1c, this is a topic that undoubtedly warrants more research …”