The Contribution of Glucose Variability to Asymptomatic Hypoglycemia in Persons with Type 2 Diabetes

Abstract

As the risk of asymptomatic hypoglycemia increases in the presence of increased glucose variability, avoidance of excess glucose fluctuations should be an important consideration for either reducing or preventing the risk of hypoglycemia in type 2 diabetes.

Improvement of β-cell function ameliorated glycemic variability in patients with newly diagnosed type 2 diabetes after short-term continuous subcutaneous insulin infusion or in combination with sitagliptin treatment: a randomized control trial

“…Similar observation also appeared in a well-designed study of 61 patients with early T2DM who were treated with MDII [14]. However, in a study of 222 patients with longduration T2DM who underwent treatment with insulin alone or in combination with oral hypoglycemic agents (OHAs), GV (SD around the mean glucose value) was positively with hypoglycemia frequency [12]. In another 24 weeks study of 2,177 T2DM patients with complications on combined therapy with basal insulin plus OHAs, Qu et al [13] found that intra-day and inter-day CV were significantly associated with the rate of hypoglycemia.…”

“…However, the importance of GV as a factor in the pathophysiology of diabetes complications is currently a matter of debate [11]. Nevertheless, at a given level of glycemia, GV has been shown predictive of hypoglycemia in type 2 diabetes mellitus (T2DM) [12,13] and hence, is clinically important. Recently, the contribution of GV to β-cell dysfunction has been particularly concerning.…”

Blood Glucose Self-Monitoring Patterns in Mexican Americans: Further Lessons from the Starr County Border Health Initiative

“…This is disappointing because (1) there is a dearth of studies that have involved analyses of glucose variability, particularly in such populations as Mexican Americans residing in impoverished rural communities, (2) glucose variability has been associated with risk of microvascular complications and increased carotid intima media thickness, (3) increased glucose variability is a strong predictor of hypoglycemia and poor glucose control, and (4) wide variability and poor control can be masked by relying on A1C values to assess management status. [20][21][22][23] SMBG is not a ''stand-alone'' diabetes therapeutic intervention. It may be difficult for persons with T2DM to see its value when it is one of several behavioral strategies recommended for daily diabetes self-management.…”

A normoglykaemia elérésének korlátai inzulinkezelt 2-es típusú cukorbetegekben

“…Ugyanakkor az is nyilvánvalónak tűnik, és irodalmi adatok alapján bizonyított, hogy magas vércukor-variabilitás mellett az átlagos vércukrok csökkentése a hypoglykaemiák kockázatának fokozódásával jár [13,14,15].…”