Integrating glycaemic variability in the glycaemic disorders of type 2 diabetes: A move towards a unified glucose tetrad concept
Abstract
The high incidence of atherosclerosis and cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with diabetes. Evidence is accumulating that postprandial hyperglycaemia is an independent risk factor for diabetes-associated complications and mortality, and that worsening diabetes control is characterized by postprandial glucose (PPG) deterioration preceding an impairment in fasting glucose levels. Postprandial and general glucose fluctuations play a major role in activating oxidative stress, leading to the endothelial dysfunction, one of the mechanisms responsible for vascular complications. Therefore, the management of PPG is key for any strategy used in the monitoring and treatment of diabetes. We recommend that any strategy aimed at controlling the glycaemic disorders associated with type 2 diabetes, and limiting the risk of complications, should target the 'glucose tetrad', which comprises the following components: HbA(1c), fasting and postprandial plasma glucose, and markers of glycaemic variability, such as the mean amplitude of glycaemic excursions (MAGE) index. This brings together, in a simple, unified concept, the conventional markers (HbA(1c) and fasting glucose) and the more recently recognized markers of glycaemic control (PPG excursions and acute glycaemic variability).
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Increased glucose variability from peaks to nadirs has been recognized as a major metabolic defect leading to endothelial damage and CVD in T2DM.
“Indeed, increased glucose variability from peaks to nadirs has been recognized as a major metabolic defect leading to endothelial damage and CVD in T2DM [81].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [81]
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- Authors
- Monnier, L., Colette, C., & Owens, D. R.
- Affiliations
- Hôpital Lapeyronie (FR)
- University Hospital Llandough (GB)
- Corresponding author
- Monnier, Louis
- Venue
- Diabetes/Metabolism Research and Reviews
- Publisher
- Wiley
- Published
- 2009-05-12
- Volume
- 25
- Issue
- 5
- Pages
- 393-402
- ISSN
- 1520-7552 (ISSN-L)
- 1520-7560
- OpenAlex
- W1985108710
- Cited by
- 89
- References
- 89
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 7 · 2018: 6 · 2017: 8 · 2016: 8 · 2015: 2 · 2014: 10 · 2013: 4 · 2012: 7
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes/Metabolism Research and Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Sanofi
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- glycemic variability, type 2 diabetes, postprandial hyperglycemia, HbA1c, fasting blood glucose, postprandial blood glucose, oxidative stress, endothelial dysfunction, cardiovascular risk, diabetes complications
- MeSH terms
- Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Monitoring, Physiologic, Postprandial Period, Atherosclerosis
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