Glucose variability, HbA1c and microvascular complications
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Microvascular complications in diabetes are associated with poor long-term diabetes control as measured by HbA1c levels. Glucose fluctuations are related to oxidative stress, endothelial dysfunction, and inflammation, factors traditionally associated with the pathogenesis of vascular damage. Glucose variability has been associated with macrovascular disease in some studies but any association with microvascular disease remains controversial. This overview summarizes recent findings in the field of glucose variability and its possible relationship with retinopathy, nephropathy and neuropathy. It is concluded that randomized prospective follow-up trials could possibly help estimate whether short-term glucose variability should be considered as an independent risk factor for microvascular complications in diabetes.
KeywordsGlucose variability HbA1c variability Microvascular complications Type 1 and Type 2 diabetes
This review was supported the Czech Health Research Council and the Ministry of Health of the Czech Republic with grant Nr. 15-26705A and by research project P25/LF1/2 of Charles University, Prague.
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Conflict of interest
The authors declare no conflicts of interest.
- 23.Ceriello A, Novials A, Ortega E, Canivell S, La Sala L, Pujadas G, et al. Vitamin C further improves the protective effect of glucagon-like peptide-1 on acute hypoglycemia-induced oxidative stress, inflammation, and endothelial dysfunction in Type 1 diabetes. Diabetes Care. 2013;36:4104–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Wang JL, Alexanian A, Ying R, Kizhakekuttu TJ, Dharmashankar K, Vasquez-Vivar J, et al. Acute exposure to low glucose rapidly induces endothelial dysfunction and mitochontrial oxidative stress role for AMP kinase. Arterioscler Thromb Vasc Biol. 2012;32:712–20.CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Hou X, Wang C, Wang S, Yang WF, Ma ZQ, Wang YL et al. Fluctuation between fasting and 2-H postload glucose state is associated with glomerular hyperfiltration in newly diagnosed diabetes patients with HbA1c, 7%. PLoS One 2014;9: doi: 10.1371/journal.pone.0111173.
- 51.Penno G, Solini A, Bonora E, Fondelli C, Orsi E, Zerbini G, et al. HbA1c variability as an independent correlate of nephropathy, but not retinopathy, in patients with type 2 diabetes. The Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicenter study. Diabetes Care. 2013;36:2301–10.CrossRefPubMedPubMedCentralGoogle Scholar
- 56.Iwasaki S, Kozawa J, Fukui K, Iwahashi H, Imagawa A, Shimomura I. Coefficient of variation of R-R interval closely correlates with glycemic variability assessed by continuous glucose monitoring in insulin-depleted patients with type 1 diabetes. Diab Res Clin Pract. 2015;109:397–403.CrossRefGoogle Scholar