Glycemic variability: how to measure and its clinical implication for type 2 diabetes
Open accessAbstract
(A1C) levels have traditionally been the gold standard for assessing glycemic control and treatment efficacy in patients with type 2 diabetes. However, A1C does not take into account fluctuations in blood glucose levels known as glycemic variability (GV). In recent years, GV has become increasingly clinically relevant, because of a better understanding of the need to reach target A1C while avoiding hypoglycemia. GV relates to both hyperglycemia and hypoglycemia, and has been associated with poorer quality of life. Diabetes treatments targeting multiple pathophysiological mechanisms are most beneficial in controlling A1C and reducing GV. In clinical trials, a number of metrics are used to measure GV, many of which are not well understood in the clinical practice. Until a gold standard metric for GV is established, the variety of measurements available may confound the choice of an optimal treatment for an individual patient.
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Glycemic variability is associated with increased risk of hypoglycemia in patients with diabetes, independently of glycated hemoglobin level.
“Recent clinical data indicate that GV is associated with increased risk of hypoglycemia, microvascular and macrovascular complications, and mortality in patients with diabetes, independently of glycated hemoglobin level.”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [13]
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Continuous Glucose Monitoring in Dogs and Cats
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Arnoriaga‐Rodríguez, M., Leal, Y., Mayneris‐Perxachs, J., Pérez‐Brocal, V., Moyá, A., Ricart, W., Fernández-Balsells, M., & Fernández‐Real, J. M. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad258 · Cited by 19 · see citing works
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Glucose variability predicts 6-month mortality in patients hospitalized with acute heart failure
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HbA1c variability associated with dementia risk in people with type 2 diabetes
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Glycemic Variability in Early Pregnancy May Predict a Subsequent Diagnosis of Gestational Diabetes
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Emerging technologies for the management of type 2 diabetes mellitus
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Mphwanthe, G., Weatherspoon, D. D., Kalimbira, A. A., & Weatherspoon, L. (2020) · Social Work in Public Health · doi:10.1080/19371918.2020.1785367 · Cited by 14 · see citing works
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GLP 1 receptor agonists, glycemic variability, oxidative stress and acute coronary syndrome
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Olveira, G., Abuín, J., López, R., Herránz, S., García‐Almeida, J. M., García-Malpartida, K., Ferrer, M., Cáncer, E., Pérez, L. M. L., Álvarez, J., et al. (2020) · Endocrine Practice · doi:10.4158/ep-2019-0482 · Cited by 9 · see citing works
Shao, D., Wang, S., Sun, J., Wang, H., & Sun, Q. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.847348 · Cited by 8 · see citing works
Salam, M., Bailey, R. J., Calhoun, P. M., McGill, J. B., Bergenstal, R. M., Price, D. A., & Beck, R. W. (2022) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2022.0387 · Cited by 9 · see citing works
Cuevas, H. E., Stuifbergen, A. M., Hilsabeck, R. C., Sales, A., Wood, S., & Kim, J. (2023) · PLoS ONE · doi:10.1371/journal.pone.0285553 · Cited by 8 · see citing works
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Sheng, T., Offringa, R., Kerr, D. E., Clements, M. A., Fischer, J., Parks, L. J., & Greenfield, M. (2019) · Journal of Diabetes Science and Technology · doi:10.1177/1932296819873641 · Cited by 7 · see citing works
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Meng, Q.-Z., Wang, Y., Li, B., Xi, Z., Wang, M., Xiu, J.-Q., & Yang, X.-P. (2023) · World Journal of Clinical Cases · doi:10.12998/wjcc.v11.i5.1019 · Cited by 7 · see citing works
Individualized diabetes care: Lessons from the real-world experience
Khor, X. Y., Pappachan, J. M., & Jeeyavudeen, M. S. (2023) · World Journal of Clinical Cases · doi:10.12998/wjcc.v11.i13.2890 · Cited by 8 · see citing works
Olmo-García, M. I. D., Hervás, D., Caudet-Esteban, J., Martín-Portugués, A. B., Rubio, A. C., Vives, M. Á. A., Catalá-Gregori, A. I., Martínez, M. P., & Merino-Torres, J. F. (2020) · Journal of International Medical Research · doi:10.1177/0300060520926063 · Cited by 7 · see citing works
Risk for Imbalanced Blood Glucose Pattern: Construct Analysis and Nursing Diagnosis Proposal
Lopes, R. O. P., Santos, J. D. C., de Oliveira, H. C., Campos, J. F., Primo, C. Ç., Lopes, C. T., & Brandão, M. A. G. (2022) · Clinical Nursing Research · doi:10.1177/10547738211073395 · Cited by 7 · see citing works
Fathi, A. E., Ganji, M., Boiroux, D., Bengtsson, H. L., & Breton, M. D. (2023) · IEEE Conference on Control Technology and Applications (CCTA) · doi:10.1109/ccta54093.2023.10253127 · Cited by 6 · see citing works
Ehrhardt, N. M., Aroda, V. R., Galindo, R. J., Peters, A. L., & Shubrook, J. H. (2023) · Clinical Diabetes · doi:10.2337/cd23-0047 · Cited by 6 · see citing works
Dhatariya, K., Humberstone, A., Hasnat, A., Wright, R. M., Lujan, M., & Nunney, I. (2021) · Diabetes Therapy · doi:10.1007/s13300-021-01146-3 · Cited by 6 · see citing works
Litchfield, I. J., Barrett, T. G., Hamilton-Shield, J. P., Moore, T. H., Narendran, P., Redwood, S., Searle, A., Uday, S., Wheeler, J., & Greenfield, S. (2022) · Diabetic Medicine · doi:10.1111/dme.15035 · Cited by 6 · see citing works
Patients’ Perspective on Barriers to Utilization of a Diabetic Retinopathy Screening Service
Owusu-Afriyie, B., Gende, T., Tapilas, M., Zimbare, N., & Kewande, J. (2023) · Diabetology · doi:10.3390/diabetology4030033 · Cited by 7 · see citing works
Irace, C., Acmet, E., Cutruzzolà, A., Parise, M., Ponzani, P., Scarpitta, A. M., & Candido, R. (2023) · Endocrine · doi:10.1007/s12020-023-03605-2 · Cited by 6 · see citing works
Impacto de la actividad física en la variabilidad glucémica en personas con diabetes mellitus tipo 2
Astrid von Oetinger, G., Gittermann, L. M. T., & Soto, N. (2021) · Rehabilitación · doi:10.1016/j.rh.2020.11.004 · Cited by 7 · see citing works
Lin, J., Cai, C., & Xie, Y. (2022) · Hormone and Metabolic Research · doi:10.1055/a-1837-0141 · Cited by 5 · see citing works
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Cañas, J. M. H., Pontificia Universidad Javeriana, B., Gómez-Gutiérrez, M., Pontificia Universidad Javeriana, B., Ossa, A. B., & Pontificia Universidad Javeriana, B. (2023) · touchREVIEWS in Endocrinology · doi:10.17925/ee.2023.19.2.4 · Cited by 5 · see citing works
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Glucose variability is a marker for COVID-19 severity and mortality
Abuhasira, R., & Grossman, A. (2022) · Archives of Endocrinology and Metabolism · doi:10.20945/2359-3997000000527 · Cited by 5 · see citing works
Construction of a QCM Biosensor for free Hemoglobin Assay
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Screening for Impaired Glucose Homeostasis: A Novel Metric of Glycemic Control
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The Implication of Time-in-Range for the Management of Diabetes in India: A Narrative Review
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Risco de glicemia instável em pessoas idosas com diabetes mellitus tipo 2
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iglu: Interpreting Glucose Data from Continuous Glucose Monitors
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- Authors
- Umpierrez, G. E., & P. Kovatchev, B.
- Affiliations
- Emory University (US)
- Corresponding author
- Umpierrez, Guillermo E.
- Venue
- The American Journal of the Medical Sciences
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 356
- Issue
- 6
- Pages
- 518-527
- ISSN
- 0002-9629 (ISSN-L)
- PMC
- PMC6709582
- OpenAlex
- W2895746197
- Cited by
- 148
- References
- 67
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 23 · 2023: 25 · 2022: 31 · 2021: 27 · 2020: 13 · 2019: 7
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The American Journal of the Medical Sciences (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- University of Virginia
- National Institute of Diabetes and Digestive and Kidney Diseases
- Merck
- National Center for Research Resources
- Sanofi
- Boehringer Ingelheim
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- glycemic variability, type 2 diabetes, HbA1c, glycemic control, hypoglycemia, hyperglycemia, quality of life
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Treatment Outcome
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