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Clinical Implications of Glucose Variability: Chronic Complications of Diabetes.

Jung HS - Endocrinol Metab (Seoul) (2015)

Bottom Line: However, there remains no generally accepted gold standard for assessing glucose variability.Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE).MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. junghs@snu.ac.kr.

ABSTRACT
Glucose variability has been identified as a potential risk factor for diabetic complications; oxidative stress is widely regarded as the mechanism by which glycemic variability induces diabetic complications. However, there remains no generally accepted gold standard for assessing glucose variability. Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE). MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems. Despite a lack of randomized controlled trials, recent clinical data suggest that long-term glycemic variability, as determined by variability in hemoglobin A1c, may contribute to the development of microvascular complications. Intraday glycemic variability is also suggested to accelerate coronary artery disease in high-risk patients.

No MeSH data available.


Related in: MedlinePlus

Twenty-four-hour glycemic curves of two patients with diabetes (red and blue lines). The two patients exhibit different patterns of glycemic variation; however, standard deviations calculated across all four points, before each meal and at bedtime (arrows), do not reflect this because the glucose measures are similar between the two patients at those points.
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Figure 1: Twenty-four-hour glycemic curves of two patients with diabetes (red and blue lines). The two patients exhibit different patterns of glycemic variation; however, standard deviations calculated across all four points, before each meal and at bedtime (arrows), do not reflect this because the glucose measures are similar between the two patients at those points.

Mentions: The simplest method of assessing intra-day variability of serum glucose is to calculate the SD or coefficient of variation (CV) of multiple SMBG readings taken over the course of a day. Usually 7-point glucose measures are used, although important fluctuations can be missed simply because they occur between two measurements (Fig. 1). Furthermore, it is difficult to obtain information on nocturnal glycemic patterns. CGM systems are able to overcome many of the issues with SMBG glucose curves, though the data are still not normally distributed, a condition necessary for calculating the SD. However, the SD correlates well with other variability measures and is the only measurement identified to date where a relationship between glucose variability and mortality in intensive care unit can be demonstrated [34]. For these reasons, some groups have suggested the SD as the preferred method for assessing intraday glucose variability [5].


Clinical Implications of Glucose Variability: Chronic Complications of Diabetes.

Jung HS - Endocrinol Metab (Seoul) (2015)

Twenty-four-hour glycemic curves of two patients with diabetes (red and blue lines). The two patients exhibit different patterns of glycemic variation; however, standard deviations calculated across all four points, before each meal and at bedtime (arrows), do not reflect this because the glucose measures are similar between the two patients at those points.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508260&req=5

Figure 1: Twenty-four-hour glycemic curves of two patients with diabetes (red and blue lines). The two patients exhibit different patterns of glycemic variation; however, standard deviations calculated across all four points, before each meal and at bedtime (arrows), do not reflect this because the glucose measures are similar between the two patients at those points.
Mentions: The simplest method of assessing intra-day variability of serum glucose is to calculate the SD or coefficient of variation (CV) of multiple SMBG readings taken over the course of a day. Usually 7-point glucose measures are used, although important fluctuations can be missed simply because they occur between two measurements (Fig. 1). Furthermore, it is difficult to obtain information on nocturnal glycemic patterns. CGM systems are able to overcome many of the issues with SMBG glucose curves, though the data are still not normally distributed, a condition necessary for calculating the SD. However, the SD correlates well with other variability measures and is the only measurement identified to date where a relationship between glucose variability and mortality in intensive care unit can be demonstrated [34]. For these reasons, some groups have suggested the SD as the preferred method for assessing intraday glucose variability [5].

Bottom Line: However, there remains no generally accepted gold standard for assessing glucose variability.Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE).MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. junghs@snu.ac.kr.

ABSTRACT
Glucose variability has been identified as a potential risk factor for diabetic complications; oxidative stress is widely regarded as the mechanism by which glycemic variability induces diabetic complications. However, there remains no generally accepted gold standard for assessing glucose variability. Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE). MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems. Despite a lack of randomized controlled trials, recent clinical data suggest that long-term glycemic variability, as determined by variability in hemoglobin A1c, may contribute to the development of microvascular complications. Intraday glycemic variability is also suggested to accelerate coronary artery disease in high-risk patients.

No MeSH data available.


Related in: MedlinePlus