Glycemic Variability Is Higher in Type 1 Diabetes Patients with Microvascular Complications Irrespective of Glycemic Control

Šoupal, Jan; Škrha, J; Fajmon, Martin; Horová, Eva; Mráz, Miloš; Prázný, Martin

doi:10.1089/dia.2013.0205

Cited by 98 publications

(70 citation statements)

References 28 publications

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“…The latter refers to intraday or interday GV, and is often measured by self‐monitoring of blood glucose or CGM. Currently, information on the association between short‐term GV and DR is limited. In type 1 diabetes mellitus, four studies using data from self‐monitoring of blood glucose reported negative findings, and one small study using CGM data observed a positive result.…”

Section: Discussionmentioning

confidence: 99%

Glycemic variability assessed by continuous glucose monitoring and the risk of diabetic retinopathy in latent autoimmune diabetes of the adult and type 2 diabetes

Zhang

et al. 2018

J of Diabetes Invest

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Aims/Introduction The relationship between glycemic variability ( GV ) and diabetic complications has gained much interest and remains under debate. Furthermore, the association of GV with diabetic complications has not been examined in latent autoimmune diabetes of the adult ( LADA ). Therefore, we evaluated the relationships among several metrics of GV with diabetic retinopathy ( DR ) in patients with LADA and type 2 diabetes mellitus. Materials and Methods A total of 192 patients with LADA and 2,927 patients with type 2 diabetes mellitus were enrolled. After continuous glucose monitoring for 72 h, three metrics of GV including standard deviation, coefficient of variation and mean amplitude of glycemic excursions were calculated. DR was assessed by fundus photography performed with a digital non‐mydriatic camera. Results The prevalence of DR was 20.3 and 26.4% in LADA and type 2 diabetes mellitus patients ( P < 0.001), respectively. Generally, LADA patients had fewer cardiometabolic risk factors than type 2 diabetes mellitus patients, and all GV metrics were significantly higher in LADA than in type 2 diabetes mellitus. In the multivariate logistic regression analysis, no metrics for GV were identified as independent risk factors of DR (standard deviation: P = 0.175; coefficient of variation: P = 0.769; mean amplitude of glycemic excursions: P = 0.388) in LADA . However, the standard deviation was significantly associated with DR ( OR 1.15, P = 0.017) in patients with type 2 diabetes mellitus after adjusting for confounders. The independent relationships of coefficient of variation and mean amplitude of glycemic excursions with DR ( P = 0.194 and P = 0.251, respectively) did not reach statistical significance in type 2 diabetes mellitus. Conclusions GV is more strongly associated with DR in type 2 diabetes than in LADA , suggesting that different glucose‐lowering strategies should be used for these two types of diabetes.

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Section: Discussionmentioning

confidence: 99%

Glycemic variability assessed by continuous glucose monitoring and the risk of diabetic retinopathy in latent autoimmune diabetes of the adult and type 2 diabetes

Zhang

et al. 2018

J of Diabetes Invest

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“…GV is defined as the intraday fluctuation in blood glucose (Cameron, Donath, & Baghurst, 2010). Emerging evidence supports the role that GV plays in the generation of oxidative stress (Quagliaro et al, 2003), endothelial dysfunction (Ceriello et al, 2012), and diabetes complications (Soupal et al, 2014). High degrees of GV are associated with more frequent episodes of hypoglycemia (Kilpatrick, Rigby, Goode, & Atkin, 2007) and glucose extremes (i.e., hypo- to hyperglycemic levels), which may occur with overtreatment of a hypoglycemic episode.…”

Section: Introductionmentioning

confidence: 92%

Fear of hypoglycemia: Influence on glycemic variability and self-management behavior in young adults with type 1 diabetes

Martyn‐Nemeth

Quinn

Penckofer

et al. 2017

Journal of Diabetes and its Complications

101

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Purpose The purpose of this study was to examine how fear of hypoglycemia (FOH) is associated with glycemic variability (GV) and self-management behavior in young adults (aged 18–35) with type 1 diabetes (T1DM). Procedures Using a prospective repeated-measures design, in 35 young adults, within- and between-person and temporal associations of FOH, specific self-management behaviors, and GV were measured. The data were collected using questionnaires and real-time measures using daily diaries, insulin pump downloads, actigraphy, and continuous glucose monitoring. Findings FOH was associated with greater glycemic variability. Significant temporal associations emerged. Concurrent day (glucose SD, p = .011) and previous-evening fear levels were associated with GV (glucose SD, p = .007). FOH was also associated with greater calorie intake (r = .492, p = .003) and less physical activity (light activity, r = −.341, p = .045). Conclusions The significant associations of FOH with GV, dietary patterns, and physical activity provide evidence for FOH as an important psychological factor associated with diabetes care.

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“…The metric most commonly used and understood for assessing and reporting GV is SD. SD of blood glucose was a predictor of the prevalence of peripheral neuropathy 89 and is associated with microvascular complications 90 and subclinical atherosclerosis in T1DM. 91 Analysis of 30 measures of quality of glycemic control and variability from patients with T1 and T2DM receiving insulin during a 1-week period of using CGM concluded that most of the GV measures were highly correlated with the overall SD, 87 somewhat validating its clinical use.…”

Section: S-20 Wright and Hirschmentioning

confidence: 99%

Metrics Beyond Hemoglobin A1C in Diabetes Management: Time in Range, Hypoglycemia, and Other Parameters

Wright

Hirsch

2017

Diabetes Technology & Therapeutics

141

114

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Glycemic Variability Is Higher in Type 1 Diabetes Patients with Microvascular Complications Irrespective of Glycemic Control

Cited by 98 publications

References 28 publications

Glycemic variability assessed by continuous glucose monitoring and the risk of diabetic retinopathy in latent autoimmune diabetes of the adult and type 2 diabetes

Glycemic variability assessed by continuous glucose monitoring and the risk of diabetic retinopathy in latent autoimmune diabetes of the adult and type 2 diabetes

Fear of hypoglycemia: Influence on glycemic variability and self-management behavior in young adults with type 1 diabetes

Metrics Beyond Hemoglobin A1C in Diabetes Management: Time in Range, Hypoglycemia, and Other Parameters

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