Minimizing Glycemic Fluctuations in Patients with Type 2 Diabetes: Approaches and Importance
Open accessAbstract
Glycemic fluctuations, characterized by short-term oscillations in plasma glucose, are important when managing type 2 diabetes (T2D) and may be considered a target of glucose-lowering therapies. Continuous glucose monitoring (CGM) has been used to evaluate the effects of different treatments on glycemic fluctuations. This review examines approaches to and the importance of minimizing glycemic fluctuations among patients with T2D. Measures of HbA1c, fructosamine, and glycated albumin reflect a long-term average of plasma glucose, and are therefore unable to provide an accurate measure of short-term glycemic oscillations. CGM provides accurate monitoring of real-time glucose fluctuations and has been used to investigate the effects of lifestyle and treatment on daily glycemic control. Dipeptidyl peptidase-4 inhibitors, sodium–glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists have demonstrated significant improvements in measures such as the mean amplitude of glucose excursions and standard deviation of CGM. Case studies of two patients with T2D utilizing CGM are also included in this review, which demonstrated that CGM was a useful tool for diagnosing unrecognized hypoglycemia and hyperglycemia in situations in which it was impractical to check fingerstick concentrations. Altogether, the evidence suggests that glycemic fluctuations are a potential target to consider when managing T2D. CGM allows for the real-time evaluation of glycemic fluctuations and may assist in the development of an individualized treatment plan to adequately control short-term oscillations in blood glucose levels.
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People with T1D may regard reducing glucose variability and improving TIR to be as important as achieving their target HbA1c value.
“As measurements of HbA1c do not reflect glycemic variability and target HbA1c values may be achieved while still experiencing marked daily glycemic fluctuations, people with T1D may regard reducing glucose variability and improving TIR to be as important as achieving their target HbA1c value.36,37”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [36]
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- Authors
- Dandona, P.
- Affiliations
- University at Buffalo, State University of New York (US)
- Corresponding author
- Dandona, Paresh
- ORCID
- Dandona, Paresh
- Venue
- Diabetes Technology & Therapeutics
- Publisher
- SAGE Publications
- Published
- 2017-09
- Volume
- 19
- Issue
- 9
- Pages
- 498-506
- ISSN
- 1520-9156 (ISSN-L)
- 1557-8593
- PMC
- PMC5647495
- OpenAlex
- W2744781443
- Cited by
- 67
- References
- 63
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 9 · 2023: 3 · 2022: 6 · 2021: 16 · 2020: 13 · 2019: 6 · 2018: 4
- FWCI
- 0.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Technology & Therapeutics (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- AstraZeneca
- 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
- glucose fluctuations, type 2 diabetes, continuous glucose monitoring, mean amplitude of glucose excursion, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, hypoglycemia, hyperglycemia, glycemic control, HbA1c limitations
- MeSH terms
- Blood Coagulation Disorders, Blood Glucose, Combined Modality Therapy, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Hypoglycemia, Practice Guidelines as Topic, Oxidative Stress, Monitoring, Ambulatory, Evidence-Based Medicine, Diabetes Complications, Precision Medicine
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