Glycemic Variability: How Do We Measure It and Why Is It Important?

Overview

Journal Diabetes Metab J

Specialty Endocrinology

Date 2015 Aug 25

PMID 26301188

Citations 160

Authors

Sunghwan Suh

Jae Hyeon Kim

Affiliations

Soon will be listed here.

Abstract

Chronic hyperglycemia is the primary risk factor for the development of complications in diabetes mellitus (DM); however, it is believed that frequent or large glucose fluctuations may independently contribute to diabetes-related complications. Postprandial spikes in blood glucose, as well as hypoglycemic events, are blamed for increased cardiovascular events in DM. Glycemic variability (GV) includes both of these events; hence, minimizing GV can prevent future cardiovascular events. Correcting GV emerges as a target to be pursued in clinical practice to safely reduce the mean blood glucose and to determine its direct effects on vascular complications in diabetes. Modern diabetes management modalities, including glucagon-related peptide-1-based therapy, newer insulins, modern insulin pumps and bariatric surgery, significantly reduce GV. However, defining GV remains a challenge primarily due to the difficulty of measuring it and the lack of consensus regarding the optimal approach for its management. The purpose of this manuscript was not only to review the most recent evidence on GV but also to help readers better understand the available measurement options and how the various definitions relate differently to the development of diabetic complications.

Citing Articles

Correlation Between Blood Glucose Fluctuations and Osteoporosis in Type 2 Diabetes Mellitus.

Chen F, Wang P, Dai F, Zhang Q, Ying R, Ai L Int J Endocrinol. 2025; 2025:8889420.

PMID: 39949568 PMC: 11824305. DOI: 10.1155/ije/8889420.

Ref-1 redox activity regulates retinal neovascularization by modulating transcriptional activation of HIF-1α.

Hartman G, Muniyandi A, Sishtla K, Kpenu E, Miller W, Kaplan B FASEB J. 2025; 39(3):e70348.

PMID: 39902892 PMC: 11792779. DOI: 10.1096/fj.202401989RR.

Impact of digital health interventions on glycemic control and weight management.

Veluvali A, Dehghani Zahedani A, Hosseinian A, Aghaeepour N, McLaughlin T, Woodward M NPJ Digit Med. 2025; 8(1):20.

PMID: 39789102 PMC: 11717909. DOI: 10.1038/s41746-025-01430-7.

Risk prediction of integrated traditional Chinese and western medicine for diabetes retinopathy based on optimized gradient boosting classifier model.

Xiao L, Tang L, Kuang W, Yang Y, Deng Y, Lu J Medicine (Baltimore). 2024; 103(51):e40896.

PMID: 39705459 PMC: 11666193. DOI: 10.1097/MD.0000000000040896.

The Association Between Time in Range %, Measured by Continuous Glucose Monitoring (CGM) and Physical Health Agility Status Indices Amongst Older People with T2D: A Cross-Sectional Study.

Basson-Shleymovich Y, Yahalom-Peri T, Azmon M, Cukierman-Yaffe T J Clin Med. 2024; 13(23).

PMID: 39685547 PMC: 11642438. DOI: 10.3390/jcm13237089.

References

Langouche L, Vanhorebeek I, Van den Berghe G . Therapy insight: the effect of tight glycemic control in acute illness. Nat Clin Pract Endocrinol Metab. 2007; 3(3):270-8. DOI: 10.1038/ncpendmet0426. View

Koga M . 1,5-Anhydroglucitol and glycated albumin in glycemia. Adv Clin Chem. 2014; 64:269-301. DOI: 10.1016/b978-0-12-800263-6.00007-0. View

. (6) Glycemic targets. Diabetes Care. 2014; 38 Suppl:S33-40. DOI: 10.2337/dc15-S009. View

Seok H, Huh J, Kim H, Lee B, Kang E, Lee H . 1,5-anhydroglucitol as a useful marker for assessing short-term glycemic excursions in type 1 diabetes. Diabetes Metab J. 2015; 39(2):164-70. PMC: 4411548. DOI: 10.4093/dmj.2015.39.2.164. View

Koga M, Kasayama S . Clinical impact of glycated albumin as another glycemic control marker. Endocr J. 2010; 57(9):751-62. DOI: 10.1507/endocrj.k10e-138. View

Cavalot F . Do data in the literature indicate that glycaemic variability is a clinical problem? Glycaemic variability and vascular complications of diabetes. Diabetes Obes Metab. 2013; 15 Suppl 2:3-8. DOI: 10.1111/dom.12140. View

Selvin E, Francis L, Ballantyne C, Hoogeveen R, Coresh J, Brancati F . Nontraditional markers of glycemia: associations with microvascular conditions. Diabetes Care. 2011; 34(4):960-7. PMC: 3064058. DOI: 10.2337/dc10-1945. 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

Muggeo M, Zoppini G, Bonora E, Brun E, Bonadonna R, Moghetti P . Fasting plasma glucose variability predicts 10-year survival of type 2 diabetic patients: the Verona Diabetes Study. Diabetes Care. 2000; 23(1):45-50. DOI: 10.2337/diacare.23.1.45. View

10.

Jeha G, Karaviti L, Anderson B, OBrian Smith E, Donaldson S, McGirk T . Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia. Diabetes Technol Ther. 2006; 7(6):876-84. DOI: 10.1089/dia.2005.7.876. View

11.

Service F . Glucose variability. Diabetes. 2013; 62(5):1398-404. PMC: 3636651. DOI: 10.2337/db12-1396. View

12.

Rodbard D . Clinical interpretation of indices of quality of glycemic control and glycemic variability. Postgrad Med. 2011; 123(4):107-18. DOI: 10.3810/pgm.2011.07.2310. View

13.

Smith-Palmer J, Brandle M, Trevisan R, Orsini Federici M, Liabat S, Valentine W . Assessment of the association between glycemic variability and diabetes-related complications in type 1 and type 2 diabetes. Diabetes Res Clin Pract. 2014; 105(3):273-84. DOI: 10.1016/j.diabres.2014.06.007. View

14.

Inchiostro S, Candido R, Cavalot F . How can we monitor glycaemic variability in the clinical setting?. Diabetes Obes Metab. 2013; 15 Suppl 2:13-6. DOI: 10.1111/dom.12142. View

15.

Nathan D, Turgeon H, Regan S . Relationship between glycated haemoglobin levels and mean glucose levels over time. Diabetologia. 2007; 50(11):2239-44. PMC: 8752566. DOI: 10.1007/s00125-007-0803-0. View

16.

Salardi S, Zucchini S, Santoni R, Ragni L, Gualandi S, Cicognani A . The glucose area under the profiles obtained with continuous glucose monitoring system relationships with HbA(lc) in pediatric type 1 diabetic patients. Diabetes Care. 2002; 25(10):1840-4. DOI: 10.2337/diacare.25.10.1840. View

17.

Chiasson J, Josse R, Gomis R, Hanefeld M, Karasik A, Laakso M . Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA. 2003; 290(4):486-94. DOI: 10.1001/jama.290.4.486. View

18.

Coutinho M, Gerstein H, Wang Y, Yusuf S . The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. 1999; 22(2):233-40. DOI: 10.2337/diacare.22.2.233. View

19.

van Haeften T, Pimenta W, Mitrakou A, Korytkowski M, Jenssen T, Yki-Jarvinen H . Relative conributions of beta-cell function and tissue insulin sensitivity to fasting and postglucose-load glycemia. Metabolism. 2000; 49(10):1318-25. DOI: 10.1053/meta.2000.9526. View

20.

Nathan D, Cleary P, Backlund J, Genuth S, Lachin J, Orchard T . Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005; 353(25):2643-53. PMC: 2637991. DOI: 10.1056/NEJMoa052187. View