Glycaemic variability: The under‐recognized therapeutic target in type 1 diabetes care

Abstract

Type 1 diabetes mellitus (T1DM) remains one of the most challenging long‐term conditions to manage. Despite robust evidence to demonstrate that near normoglycaemia minimizes, but does not completely eliminate, the risk of complications, its achievement has proved almost impossible in a real‐world setting. HbA1c to date has been used as the gold standard marker of glucose control and has been shown to reflect directly the risk of diabetes complications. However, it has been recognized that HbA1c is a crude marker of glucose control. Continuous glucose monitoring (CGM) provides the ability to measure and observe inter‐ and intraday glycaemic variability (GV), a more meaningful measure of glycaemic control, more relevant to daily living for those with T1DM. This paper reviews the relationship between GV and hypoglycaemia, and micro‐ and macrovascular complications. It also explores the impact on GV of CGM, insulin pumps, closed‐loop technologies, and newer insulins and adjunctive therapies. Looking to the future, there is an argument that GV should become a key determinant of therapeutic success. Further studies are required to investigate the pathological and psychological benefits of reducing GV.

Impact of Switching from Intermittently Scanned to Real-Time Continuous Glucose Monitoring Systems in a Type 1 Diabetes Patient French Cohort: An Observational Study of Clinical Practices

“…8 This confirms hypoglycemia's major role on glycemic variability, an association to be considered in the context of the current debate on the link between these two glycemic disorders with the risk of vascular complications. 21,22 Despite an inverse relationship between TIR and HbA1c described in the literature (which we observed herein for both CGM devices, data not shown), the significant increase in FIG. 4.…”

Bioinformatic Reconstruction and Analysis of Gene Networks Related to Glucose Variability in Diabetes and Its Complications

“…Maintenance of GV within normal values is provided by a complex regulatory molecular-genetic network, which remains not fully understood. Many patients with diabetes have increased GV, which might be a major therapeutic challenge [ 1 , 2 ]. The highest GV is observed in insulin-treated type 1 and type 2 diabetic subjects.…”

Individualizing Time-in-Range Goals in Management of Diabetes Mellitus and Role of Insulin: Clinical Insights From a Multinational Panel

“…Hypoglycemia is more common in individuals with increased GV [ 36 ]. A pooled analysis of six randomized controlled trials (RCTs) conducted among people with T2DM treated with 24 weeks of Gla-100 or comparators demonstrated that all measures of GV were significantly associated with poor glycemic control and the development of hypoglycemia during the trial [ 38 ]. Moreover, intraday GV is associated with a higher risk of nocturnal and overall hypoglycemia, and a decrease in GV is strongly correlated with a reduction in both hyperglycemic and hypoglycemic episodes [ 36 ].…”