Glycemic Variability: Clinical and Prognostic Significance
Minimizing development or progression of chronic diabetic micro and macro-vascular
complications has been always the goal of glycemic control. In recent years, much attention
has been focused on the possibility that glycemic variability confers an additional risk factor
for diabetic complications independent of glycated hemoglobin.
Evidence suggests that fluctuating glucose levels produce endothelial dysfunction as well as an
increase in free radicals, the key link between hyperglycemia and diabetic complications and
that these changes are greater than those produced by sustained hyperglycemia in in vitro and in animal studies.
In humans studies, experimental setting also support the hypothesis that plasma glucose fluctuations
produce a higher increase in oxidative stress as well as endothelial dysfunction than
those produced by sustained hyperglycemia in type 2 diabetes.
Moreover, glycemic variability may have a role in the prediction of severe hypoglycemia,
which may act as a precipitating factor of diabetic complications. Based on review of available evidence,
we advocate decreasing hyperglycemia and diminishing glycemic variability as well as avoiding hypoglycemia in
diabetic patients as targets of diabetic therapy.
Future trials targeting the influence of the control of plasma glucose fluctuations on the development
of diabetic micro-and macro-vascular complications are needed to further strengthen the evidence base.
Diabetes is ranked among the leading causes of morbidity and mortality, and is a tremendous cost
burden in medical care. Although glycated hemoglobin has been considered the surrogate endpoint for
long-term glycemic control; recent evidence has raised the question that plasma glycemic variability,
irrespective of HbA1c level, may confer an addition risk for the development of diabetic complications.
Diabetes Res Open J. 2015; 1(2): 48-53. doi: 10.17140/DROJ-1-108
