Glucose Variability: Where It is Important and How to Measure It

Overview

Journal Diabetes

Specialty Endocrinology

Date 2013 Apr 25

PMID 23613566

Citations 89

Authors

J Hans DeVries

Affiliations

Soon will be listed here.

Abstract

Glucose variability predicts hypoglycemia in both type 1 and type 2 diabetes and has consistently been related to mortality in nondiabetic patients in the intensive care unit. SD and mean amplitude of glycemic excursions have historically been very popular measures of glucose variability. For reasons outlined in this counterpoint, I propose to use coefficient of variation and the mean absolute glucose change as preferred measures of glucose variability.

Citing Articles

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References

Raz I, Wilson P, Strojek K, Kowalska I, Bozikov V, Gitt A . Effects of prandial versus fasting glycemia on cardiovascular outcomes in type 2 diabetes: the HEART2D trial. Diabetes Care. 2009; 32(3):381-6. PMC: 2646013. DOI: 10.2337/dc08-1671. View

Rodbard D . New and improved methods to characterize glycemic variability using continuous glucose monitoring. Diabetes Technol Ther. 2009; 11(9):551-65. DOI: 10.1089/dia.2009.0015. View

Borg R, Kuenen J, Carstensen B, Zheng H, Nathan D, Heine R . Associations between features of glucose exposure and A1C: the A1C-Derived Average Glucose (ADAG) study. Diabetes. 2010; 59(7):1585-90. PMC: 2889756. DOI: 10.2337/db09-1774. View

Siegelaar S, Holleman F, Hoekstra J, DeVries J . Glucose variability; does it matter?. Endocr Rev. 2009; 31(2):171-82. DOI: 10.1210/er.2009-0021. View

Cox D, Kovatchev B, Julian D, Gonder-Frederick L, Polonsky W, Schlundt D . Frequency of severe hypoglycemia in insulin-dependent diabetes mellitus can be predicted from self-monitoring blood glucose data. J Clin Endocrinol Metab. 1994; 79(6):1659-62. DOI: 10.1210/jcem.79.6.7989471. View

Wentholt I, Kulik W, Michels R, Hoekstra J, DeVries J . Glucose fluctuations and activation of oxidative stress in patients with type 1 diabetes. Diabetologia. 2007; 51(1):183-90. DOI: 10.1007/s00125-007-0842-6. View

Siegelaar S, Barwari T, Kulik W, Hoekstra J, DeVries J . No relevant relationship between glucose variability and oxidative stress in well-regulated type 2 diabetes patients. J Diabetes Sci Technol. 2011; 5(1):86-92. PMC: 3045241. DOI: 10.1177/193229681100500112. View

Qu Y, Jacober S, Zhang Q, Wolka L, DeVries J . Rate of hypoglycemia in insulin-treated patients with type 2 diabetes can be predicted from glycemic variability data. Diabetes Technol Ther. 2012; 14(11):1008-12. DOI: 10.1089/dia.2012.0099. View

Kilpatrick E, Rigby A, Goode K, Atkin S . Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetes. Diabetologia. 2007; 50(12):2553-61. DOI: 10.1007/s00125-007-0820-z. View

10.

Monnier L, Wojtusciszyn A, Colette C, Owens D . The contribution of glucose variability to asymptomatic hypoglycemia in persons with type 2 diabetes. Diabetes Technol Ther. 2011; 13(8):813-8. DOI: 10.1089/dia.2011.0049. View

11.

Hermanides J, Vriesendorp T, Bosman R, Zandstra D, Hoekstra J, DeVries J . Glucose variability is associated with intensive care unit mortality. Crit Care Med. 2009; 38(3):838-42. DOI: 10.1097/CCM.0b013e3181cc4be9. View

12.

Siegelaar S, Kerr L, Jacober S, DeVries J . A decrease in glucose variability does not reduce cardiovascular event rates in type 2 diabetic patients after acute myocardial infarction: a reanalysis of the HEART2D study. Diabetes Care. 2011; 34(4):855-7. PMC: 3064040. DOI: 10.2337/dc10-1684. View

13.

Baghurst P . Calculating the mean amplitude of glycemic excursion from continuous glucose monitoring data: an automated algorithm. Diabetes Technol Ther. 2011; 13(3):296-302. DOI: 10.1089/dia.2010.0090. View

14.

Eslami S, Taherzadeh Z, Schultz M, Abu-Hanna A . Glucose variability measures and their effect on mortality: a systematic review. Intensive Care Med. 2011; 37(4):583-93. PMC: 3058514. DOI: 10.1007/s00134-010-2129-5. View

15.

Snell-Bergeon J, Roman R, Rodbard D, Garg S, Maahs D, Schauer I . Glycaemic variability is associated with coronary artery calcium in men with Type 1 diabetes: the Coronary Artery Calcification in Type 1 Diabetes study. Diabet Med. 2010; 27(12):1436-42. PMC: 3052953. DOI: 10.1111/j.1464-5491.2010.03127.x. View

16.

McDonnell C, Donath S, Vidmar S, Werther G, Cameron F . A novel approach to continuous glucose analysis utilizing glycemic variation. Diabetes Technol Ther. 2005; 7(2):253-63. DOI: 10.1089/dia.2005.7.253. View

17.

Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol J . Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006; 295(14):1681-7. DOI: 10.1001/jama.295.14.1681. View

18.

Facchinetti A, Sparacino G, Guerra S, Luijf Y, DeVries J, Mader J . Real-time improvement of continuous glucose monitoring accuracy: the smart sensor concept. Diabetes Care. 2012; 36(4):793-800. PMC: 3609535. DOI: 10.2337/dc12-0736. View

19.

Siegelaar S, Kilpatrick E, Rigby A, Atkin S, Hoekstra J, DeVries J . Glucose variability does not contribute to the development of peripheral and autonomic neuropathy in type 1 diabetes: data from the DCCT. Diabetologia. 2009; 52(10):2229-32. PMC: 2744825. DOI: 10.1007/s00125-009-1473-x. View

20.

Rodbard D . Optimizing display, analysis, interpretation and utility of self-monitoring of blood glucose (SMBG) data for management of patients with diabetes. J Diabetes Sci Technol. 2009; 1(1):62-71. PMC: 2769603. DOI: 10.1177/193229680700100111. View