Diabetes &Blood Glucose variation
Glucose variation means glycemic variability
In scientific term
To know glycemic variability
First what is glycemic ? Glycemic means
How fast the glucose rises in the blood
Higher the glycemia means high glucose in blood
Or hyperglycemia.
Lower the glycemia means low glucose
In blood or hypoglycemia.
Glycated hemoglobin or
HbA1 c are similar Terms
HbA1c reflects previous 3 months glycemic control.
This test HbA 1c is the gold standard for long
Term glycemic control and response to
medical treatment in patients with diabetes.
Glycated Hemoglobin ,however doesn't
Address fluctuations in blood glucose.
Glycemic variation (GV) :
Is associated with increased risk
Of hypoglycemia , microvascular ( small artery
Disease)
and
Macrovascular complications:( large blood
Vessel disease) ,and mortality
In patients with diabetes independently
Of HbA1c .
The use of continuous glucose monitoring
Devices has markedly improved the
Assessment of GV in clinical practice.
And facilitated the assessment GV
Hyperglycemia ,hypoglycemia events
In patients with diabetes.
High HbA1c is risk indicator of diabetic
Complications .
HbA1c treatment goal 6.5% to 7.5%
Several studies have reported that reductions
In HbA1c is associated with significant
Reduction in microvascular complications
(Retinopathy ,Nephropathy, and Neuropathy)
Retinopathy retina eye disease retina is the screen of the eye
Nephropathy;Kidney disease
Neuropathy :Nerve disorder
As well as decreased cardiovascular
and diabetes--–related mortality.
HbA1c does not address
short term
Glycemic variability (GV)
Or daily fluctuations in blood glucose
Levels or hypoglycemic events.
GV to help clinicians and patients to overcome
the limitations of HbA1c in diabetes management.
Glycemic variability refers to swings in
Blood glucose levels.It means oscillations
that occur throughout the day.Including
Episodes Of hypoglycemia and post prandial
Hyperglycemia.
Reduction in HbA1c leads to lower rates
In diabetic complications.
CGM : Continuous glucose monitoring
Sensors introduced in 1999
Is a better way to assess GV (Glycemic variation)
CGM measures interstial glucose every 1
To 5min
Mitigating the need of capillary SMBG(
Self Glucose monitored blood glucose
Capillary blood)
Anti diabetic strategy :
Aim HbA1c Fasting Post prandial glucose
As well as GV by frequent blood glucose
Concentrations measurements in
Continuous time fashion.
Using CGM.
Measurements .
Ref BMJ Open Diabetes Res Care
2021 : 9(1)e002032
Marcela Martinez
Jimena Santamarina
Adrian Pravesi
Carla Musso
And
Guillermo E Umpierrez
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