Glycemic Variability

Abstract

Diabetes is characterized by glycemic disorders that include both sustained chronic hyperglycemia and acute glucose fluctuations. There is now cogent evidence for the deleterious effects of sustained chronic hyperglycemia that results in excessive protein glycation and generation of oxidative stress. The role of glucose variability from peaks to nadirs is less documented, but there are many reasons to think that both upward (postprandial) and downward (interprandial) acute fluctuations of glucose around a mean value activate the oxidative stress. As a consequence, it is strongly suggested that a global antidiabetic strategy should be aimed at reducing to a minimum the different components of dysglycemia (i.e., A1C, fasting and postprandial glucose, as well as glucose variability). All the therapeutic agents that act on postprandial glucose excursions seem of particular interest for reducing the latter parameter (i.e., the glucose instability). Particular attention should be paid to such emerging therapeutic agents as the glucagon-like peptide 1 agonists and the dipeptidyl peptidase (DPP)-IV inhibitors that act through the incretin pathway.Diabetes Care 31 (Suppl. 2):S150-S154, 2008

Reducing glycaemic variability in type 1 diabetes self-management with a continuous glucose monitoring system based on wired enzyme technology

“…The importance of glycaemic variability for various outcomes in diabetes [5], but also in critically ill patients [6] is receiving more and more attention. In patients with type 2 diabetes a significant association has been reported between the mean amplitude of glycaemic excursions (MAGE), an established variable for glycaemic variability [7] and urinary 8-iso-prostaglandin F2 alpha, a variable related to superoxide overproduction and subsequent development of later complications [8].…”

The Effect of Basal Analog Insulin on the Glycemic Variability in Type 2 Diabetics

“…However, the LANMET study using HbA1c and 8-point capillary glucose measurement as marker of glucose control has reported similar improvement with insulin glargine and NPH insulin added to the treatment of Type 2 diabetic patients who had not used insulin. An equal decrease in capillary blood glucose measurement values was found in different periods of the day and the glycemic variability was not affected (11,16). The Study of Once Daily Levemir (SOLVE) evaluating the effectiveness of single-dose insulin detemir in 1671 patients have demonstrated a significant improvement in HbA1c, fasting plasma glucose, hypoglycemic events and glycemic variability when once-daily insulin detemir was added (17).…”

“…Fasting hyperglycemia, acute or sustained postprandial hyperglycemia, and more generally, acute glucose fluctuations lead to oxidative stress. The resulting effect is the increased risk of complications as depicted by the diagonal arrow of a geometric cube consisting of fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and glucose fluctuations for the three axes The resulting effect is the risk of complications depicted by the diagonal arrow of a geometric cube for which three-dimensional coordinates on the three axes are fasting plasma glucose, postprandial glucose, and glucose fluctuations (10,11). This suggests that therapy for patients with T2DM should not only target HbA1c as a long-term goal, also should aim to avoid acute glucose fluctuations as an immediate goal.…”

Use of Insulin Pumps in India: Suggested Guidelines Based on Experience and Cultural Differences

“…It has been shown that the development of diabetes complications depends not only on glycemic control per se, but also on the magnitude of glycemic excursions in a patient, which is usually measured as the mean amplitude of glycemic excursions. 6 None of the currently available multiple-injection insulin regimens can decrease the mean amplitude of glycemic excursions to physiological levels.…”