Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature (original) (raw)
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Glycemic Variability and Vascular Complications in Patients with Type 2 Diabetes Mellitus
Folia medica, 2017
Presence of macro- and microvascular complications in patients with diabetes mellitus (DM) is not only related to chronic hyperglycemia represented by glycated hemoglobin (HbA1c) but also to acute glycemic fluctuations (glycemic variability, GV). The association between GV and DM complications is not completely clear. Aim of our study was to evaluate GV by MAGE index in patients with type 2 DM and to verify association of MAGE index with presence of macro- and microvascular DM complications. 99 patients with type 2 DM were included in the study. Every patient had done big glycemic profile, from which MAGE index was calculated. Anthropometric measurements, evaluation of HbA1c and fasting plasma glucose (FPG) and assessment for macrovascular (coronary artery disease - CAD; peripheral artery disease - PAD; cerebral stroke - CS) and microvascular (diabetic retinopathy - DR; nephropathy - DN; peripheral neuropathy - DPPN) DM complications were done. Average MAGE index value was 5.15 ± 2....
Diabetic Medicine, 2019
In 2010, the James Lind Alliance published a "top 10" list of priorities for type 1 diabetes research. Whether reducing fluctuations in blood glucose can prevent long-term microvascular and macrovascular complications was one of these. In this narrative review, we have assessed the updated evidence for the assertion that increased glucose variability plays an independent and clinically important role in the complications of type 1 diabetes, over and above mean blood glucose and the effects of hypoglycaemia: the "glucose variability hypothesis." While studies in cultured cells and ex vivo vessels have been suggestive, most studies in type 1 diabetes have been small and/or crosssectional and based on "fingerprick" glucose measurements that capture glucose variability only in waking hours and are affected by missing data. A recent analysis of the Diabetes Control and Complications Trial that formally imputed missing data found no independent effect of short-term glucose variability on long-term complications. Few other high quality longitudinal studies have directly addressed the glucose variability hypothesis in type 1 diabetes. We conclude that there is little substantial evidence to date to support this hypothesis in type 1 diabetes, although increasing use of continuous glucose monitoring (CGM) provides an opportunity to test it more definitively. In the meantime, we recommend that control of glycaemia in type 1 diabetes should continue to focus on sustained achievement of target HbA1c and avoidance of hypoglycaemia.
Glycemic variability and cardiovascular disease in patients with type 2 diabetes
BMJ Open Diabetes Research & Care, 2021
Glycated hemoglobin is currently the gold standard for assessment of long-term glycemic control and response to medical treatment in patients with diabetes. Glycated hemoglobin, however, does not address fluctuations in blood glucose. Glycemic variability (GV) refers to fluctuations in blood glucose levels. Recent clinical data indicate that GV is associated with increased risk of hypoglycemia, microvascular and macrovascular complications, and mortality in patients with diabetes, independently of glycated hemoglobin level. The use of continuous glucose monitoring devices has markedly improved the assessment of GV in clinical practice and facilitated the assessment of GV as well as hypoglycemia and hyperglycemia events in patients with diabetes. We review current concepts on the definition and assessment of GV and its association with cardiovascular complications in patients with type 2 diabetes.
Nutrition, Metabolism and Cardiovascular Diseases, 2012
The aim of this review is to focus on intra-day glucose variability (GV), specifically reviewing its correlation with HbA1c, the methods currently available to measure it, and finally the relationship between GV and cardiovascular outcomes, in type 1 and type 2 diabetic patients, and in the non-diabetic population. Data synthesis: The term GV has been used in the literature to express many different concepts; in the present review, we focus our attention on intra-day GV. In particular, we try to assess whether GV provides additional information on glycemic control beyond HbA1c, since GV seems to be incompletely expressed by HbA1c, particularly in patients with good metabolic control. Many different indexes have been proposed to measure GV, however at the moment no "gold standard" procedure is available. Evidence in vitro, in experimental settings and in animal studies, shows that fluctuating glucose levels display a more deleterious effect than constantly high glucose exposure. However, these findings are not completely reproducible in human settings. Moreover, the relationship between GV and cardiovascular events is still controversial. Conclusions: The term GV should be reserved to indicate intra-day variability and different indexes of GV should be used, depending on the metabolic profile of the population studied and the specific issue to be investigated. Self glucose monitoring or continuous glucose monitoring should be used for assessing glucose variability.
Glycaemic instability is an underestimated problem in Type II diabetes
Clinical Science, 2006
The aim of the present study was to assess the level of glycaemic control by the measurement of 24 h blood glucose profiles and standard blood analyses under identical nutritional and physical activity conditions in patients with Type II diabetes and healthy normoglycaemic controls. A total of 11 male patients with Type II diabetes and 11 healthy matched controls participated in a 24 h CGMS (continuous subcutaneous glucose-monitoring system) assessment trial under strictly standardized dietary and physical activity conditions. In addition, fasting plasma glucose, insulin and HbA 1c (glycated haemoglobin) concentrations were measured, and an OGTT (oral glucose tolerance test) was performed to calculate indices of whole-body insulin sensitivity, oral glucose tolerance and/or glycaemic control. In the healthy control group, hyperglycaemia (blood glucose concentration > 10 mmol/l) was hardly present (2 + − 1 % or 0.4 + − 0.2/24 h). However, in the patients with Type II diabetes, hyperglycaemia was experienced for as much as 55 + − 7 % of the time (13 + − 2 h over 24 h) while using the same standardized diet. Breakfast-related hyperglycaemia contributed most (46 + − 7 %; P < 0.01 as determined by ANOVA) to the total amount of hyperglycaemia and postprandial glycaemic instability. In the diabetes patients, blood HbA 1c content correlated well with the duration of hyperglycaemia and the postprandial glucose responses (P < 0.05). In conclusion, CGMS determinations show that standard measurements of glycaemic control underestimate the amount of hyperglycaemia prevalent during real-life conditions in Type II diabetes. Given the macro-and micro-vascular damage caused by postprandial hyperglycaemia, CGMS provides an excellent tool to evaluate alternative therapeutic strategies to reduce hyperglycaemic blood glucose excursions.
Long Term Complication of Poor Glycemic Control in Diabetic Patients
2020
Introduction: Diabetes mellitus is a metabolic disease characterized by hyperglycemia. The hyperglycemia is mostly due to a defect in insulin secretion and action or both. Though advancement in pharmaceutical intervention and improved lifestyle habits have aimed at preventing diabetes by controlling prolong hyperglycemic state. But despite all the efforts, diabetes at the chronic stage presents various life-threatening complications due to poor glycemic control. There is a various microvascular and macrovascular complication of chronic diabetes. Complication varies from Hyperglycemia plays an important role in microvasculopathy but also appears to be a causative factor in macrovasculopathy. The treatment of diabetes attempts to decrease tissue harm due to hyperglycemia and ensure adequate glucose delivery to various tissues of the body. Aim of the Study: The study aims to understand the various complication of diabetes mellitus in chronic stages due to poor glycemic control. Methodology: The review is a comprehensive research of PUBMED since the year 1998 to 2017. Conclusion: The importance of controlling the hyperglycemic state cannot be overstated. There is a major effect of hyperglycemia on human vasculature, and it is one of the major reasons for significant morbidity and mortality in both type-1 and type-2 diabetes. The microvascular complication is diabetic neuropathy, nephropathy, and retinopathy, while the macrovascular complication is coronary artery disease, peripheral arterial disease, and stroke. Thus, it is imperative for physicians to understand the relation between diabetes and vascular diseases and resolve the poor hyperglycemic state.
Glycaemic variability in diabetes: clinical and therapeutic implications
The lancet. Diabetes & endocrinology, 2018
Glycaemic variability is an integral component of glucose homoeostasis. Although it has not yet been definitively confirmed as an independent risk factor for diabetes complications, glycaemic variability can represent the presence of excess glycaemic excursions and, consequently, the risk of hyperglycaemia or hypoglycaemia. Glycaemic variability is currently defined by a large and increasing number of metrics, representing either short-term (within-day and between-day variability) or long-term glycaemic variability, which is usually based on serial measurements of HbA or other measures of glycaemia over a longer period of time. In this Review, we discuss recent evidence examining the association between glycaemic variability and diabetes-related complications, as well as non-pharmacological and pharmacological strategies currently available to address this challenging aspect of diabetes management.