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Cited by 158Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

Glycemic variability and cardiovascular disease in patients with type 2 diabetes

Open access
Martinez, Marcela, Santamarina, Jimena, Pavesi, Adrian, Musso, Carla, Umpierrez, Guillermo E·2021·BMJ Open Diabetes Research & Care
DOI 10.1136/bmjdrc-2020-002032PMC PMC7993171
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Abstract

Glycated hemoglobin is currently the gold standard for assessment of long-term glycemic control and response to medical treatment in patients with diabetes. Glycated hemoglobin, however, does not address fluctuations in blood glucose. Glycemic variability (GV) refers to fluctuations in blood glucose levels. 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. The use of continuous glucose monitoring devices has markedly improved the assessment of GV in clinical practice and facilitated the assessment of GV as well as hypoglycemia and hyperglycemia events in patients with diabetes. We review current concepts on the definition and assessment of GV and its association with cardiovascular complications in patients with type 2 diabetes.

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes definitions and assessment of glycemic variability (GV) and evidence linking GV to cardiovascular complications in type 2 diabetes, noting associations independent of HbA1c in many studies but not all. It concludes that clear data confirming GV as an independent risk factor for diabetic complications are still lacking and calls for prospective randomized CGM trials.

Key findings

  • GV refers to blood glucose swings, including hypoglycemia and postprandial hyperglycemia; CGM metrics include time in range 70–180 mg/dL, time above/below range, and GV expressed as coefficient of variation (CV), with a recommended CV target ≤36%. The International Consensus on Use of Continuous Glucose Monitoring recommended CV as the preferred measure and SD as secondary.
  • A meta-analysis by Gorst et al. found that in patients with T2D, higher HbA1c variability was associated with renal disease (risk ratio 1.34, 95% CI 1.15 to 1.57), macrovascular events (1.21, 1.06 to 1.38), cardiovascular disease (1.27, 1.15 to 1.40), and mortality (1.34, 1.18 to 1.53).
  • In ADVANCE, HbA1c visit-to-visit variation was associated with increased risk of vascular events (p=0.01, HR 1.64, 1.05–2.55), macrovascular events (p=0.02), and mortality (p<0.001, HR 3.31, 1.57–6.98); fasting glucose visit-to-visit variation was associated with cardiovascular events (p<0.001, HR 2.70, 1.65–4.42) and macrovascular and microvascular events.
  • In DEVOTE 2, high day-to-day fasting GV was associated with severe hypoglycemia (HR 4.11, 3.15–5.35), MACE (HR 1.36, 1.12–1.65), and all-cause mortality (HR 1.58, 1.23–2.03). However, HEART2D, DIGAMI 2, and FLAT-SUGAR reported no association or no significant difference in cardiovascular outcomes despite GV changes.

Methods

  • Narrative review of current concepts on the definition and assessment of GV and its association with cardiovascular complications in patients with type 2 diabetes.
  • Synthesizes experimental, clinical, observational, meta-analytic, and post-hoc trial evidence, including a table of studies assessing GV and cardiovascular outcomes in T2D, acute coronary syndrome, and acute myocardial infarction populations.
  • No systematic search strategy, primary data collection, or formal risk-of-bias assessment is described.

Limitations

  • The paper states there is currently no consensus on metrics to assess GV; heterogeneity between studies, including different GV metrics, limits understanding of relationships between GV and diabetes complications.
  • The paper states that clear data confirming GV as an independent risk factor of diabetic complications are still lacking, and future prospective randomized clinical trials using CGM devices are needed.
  • Evident from the text: this is a narrative review, and the cited studies vary in populations, GV measures (SMBG, CGM, HbA1c, fasting glucose), follow-up duration, and outcomes, with some reporting null associations.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bmjdrc-2020-002032

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 74 cited sources checked · 0 supported · 0 flagged

  • Premisereasoning

    The combination of reduced nitric oxide availability and increased vasoconstrictor production plays a role in the development of vascular atherosclerotic changes.

    “The combination of reduced NO availability and increased vasoconstrictor production has been shown to play a role in the development of vascular atherosclerotic changes.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Glycemic variability may be a better predictor of complications than average glucose by self-monitored blood glucose and glycated hemoglobin values.

    “GV has emerged as an important tool in the evaluation of glycemic control, which may be a better predictor of complications than average glucose by SMBG and HbA1c values.20 25 31”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 20 25 31

      Not checked in the free run.

  • Premisecitation

    Glycemic variability is associated with macrovascular complications in patients with diabetes.

    “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.”
    • Also stated in: § Methods of GV assessment · plain
      “GV metrics have been associated with microvascular complications15 32 33 as well as increased risk of adverse cardiovascular outcomes in patients with diabetes.19 21 23 25 34”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 19 21 23 25 34

      Not checked in the free run.

  • Premisecitation

    Long-term glycemic variability is a better predictor of adverse outcomes than average HbA1c.

    “In these studies, long-term GV has shown to be a better predictor of adverse outcomes than the average HbA1c.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Long-term glycemic variability has been reported in observational studies and meta-analyses to predict diabetic complications in both type 1 and type 2 diabetes.

    “Long-term GV has been reported in observational studies and meta-analyses to predict diabetic complications in both T1D and T2D.15 19 21 31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 15 19 21 31

      Not checked in the free run.

  • Classified as probably not a substantial claim. 5
  • May combine two claims. 24

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The use of continuous glucose monitoring devices has markedly improved the assessment of glycemic variability in clinical practice and facilitated the assessment of glycemic variability as well as hypoglycemia and hyperglycemia events in patients with diabetes.

    “The use of continuous glucose monitoring devices has markedly improved the assessment of GV in clinical practice and facilitated the assessment of GV as well as hypoglycemia and hyperglycemia events in patients with diabetes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Hyperglycemia and protein kinase C activation-induced reactive oxygen species production result in inflammatory changes in the vascular endothelium, including monocyte adhesion, foam cell formation, and activation of the polyol pathway and increased formation of advanced glycation end products.

    “Hyperglycemia and PKC activation-induced ROS production result in inflammatory changes in the vascular endothelium including monocytes adhesion, formation of foam cells, and activation of major biochemical paths including polyol pathway flux and increased formation of advanced glycation end products, further contributing to the development of atherosclerosis.40”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] source

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    Premisecitation

    Daily fluctuations in blood glucose are associated with endothelial dysfunction, inflammation and oxidative stress.

    “increasing evidence indicates that daily fluctuations in blood glucose are associated with endothelial dysfunction,23–25 inflammation and oxidative stress,22 24”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [23] Scott, 2020, Long-term glycemic variability and vascular complications in type 2 diabetes: post hoc analysis of the field study, J Clin Endocrinol Metab source

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    • cites [24] source

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    • cites [25] source

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    • cites 22 24

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    Premisecitation

    Hyperglycemia triggers the activation of protein kinase C, which affects vascular cell growth and apoptosis, extracellular matrix synthesis, and altered vascular homeostasis.

    “In addition, hyperglycemia triggers the activation of protein kinase C (PKC), which has an effect on vascular cell growth and apoptosis, extracellular matrix synthesis, and altered vascular homeostasis.24 38”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 24 38

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Protein kinase C increases production of reactive oxygen species, which decreases nitric oxide availability and causes overproduction of vasoconstrictors such as endothelin-1 and cyclo-oxygenase-2 expression.

    “PKC also increases production of ROS, which decreases NO availability and overproduction of vasoconstrictors such as endothelin-1 and cyclo-oxygenase-2 expression, molecules involved in platelet aggregation and vasoconstriction.39”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Endothelial dysfunction, inflammation and oxidative stress are factors associated with the pathogenesis of vascular damage and atherosclerosis.

    “factors associated with the pathogenesis of vascular damage and atherosclerosis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Hyperglycemia increases the production of reactive oxygen species, which inactivates nitric oxide, leading to endothelial dysfunction and vascular complications.

    “Hyperglycemia increases the production of reactive oxygen species (ROS), which inactivates nitric oxide (NO),19 38 leading to endothelial dysfunction and vascular complications.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 19 38

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Takahashi et al, mean amplitude of glycemic excursion was associated with increased MACCE (23.5% vs 11.6%, p=0.002) and was an independent predictor of poor prognosis (p=0.045, HR 1.84, 1.01-3.36).

    “MAGE was associated with increased MACCE (23.5% vs 11.6%, p=0.002) and was an independent predictor of poor prognosis (p= 0.045, HR 1.84, 1.01–3.36).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Takahashi, 2018, Glycemic variability determined with a continuous glucose monitoring system can predict prognosis after acute coronary syndrome, Cardiovasc Diabetol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In ADVANCE, increased HbA1c visit-to-visit variation was associated with increased risk of vascular events (p=0.01, HR 1.64, 1.05-2.55), macrovascular events (p=0.02), and mortality (p<0.001, HR 3.31, 1.57-6.98).

    “Increased HbA1c visit-to-visit variation was associated with increased risk of vascular events (p=0.01, HR 1.64, 1.05–2.55), macrovascular events (p=0.02), and mortality (p<0.001, HR 3.31, 1.57–6.98).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] source

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  • May combine two claims.

    Premisecitation

    Sustained hyperglycemia measured by high HbA1c or by continuous glucose monitoring and increased glycemic variability are important factors associated with cardiovascular outcomes in patients with type 2 diabetes.

    “Sustained hyperglycemia measured by high HbA1c or by CGM and increased GV are important factors associated with cardiovascular outcomes in patients with T2D.21 34 48”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 21 34 48

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In ADVANCE, fasting glucose visit-to-visit variation was associated with increased risk of cardiovascular events (p<0.001, HR 2.70, 1.65-4.42) and macrovascular (p=0.005) and microvascular (p<0.001) events.

    “FG visit-to-visit variation was associated with increased risk of CV events (p<0.001, HR 2.70, 1.65–4.42) and macrovascular (p=0.005) and microvascular (p<0.001) events.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with type 2 diabetes at high risk of cardiovascular events in DEVOTE 2, high day-to-day fasting glycemic variability was significantly associated with all-cause mortality, with a 1.4-fold increased risk when fasting glycemic variability was duplicated.

    “High day-to-day fasting GV was significantly associated with severe hypoglycemia, MACE and all-cause mortality; risks raised 2.7-fold, 1.2-fold and 1.4-fold, respectively, when fasting GV was duplicated.49”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Zinman, 2018, Day-to-day fasting glycaemic variability in DEVOTE: associations with severe hypoglycaemia and cardiovascular outcomes (DEVOTE 2), Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    High glucose fluctuations increase oxidative stress in heart tissue and can induce cardiomyocyte apoptosis.

    “Increasing evidence indicates that high glucose fluctuations also increase oxidative stress in heart tissue and can induce cardiomyocyte apoptosis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In patients with type 2 diabetes at high risk of cardiovascular events in DEVOTE 2, high day-to-day fasting glycemic variability was significantly associated with severe hypoglycemia, with a 2.7-fold increased risk when fasting glycemic variability was duplicated.

    “High day-to-day fasting GV was significantly associated with severe hypoglycemia, MACE and all-cause mortality; risks raised 2.7-fold, 1.2-fold and 1.4-fold, respectively, when fasting GV was duplicated.49”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Zinman, 2018, Day-to-day fasting glycaemic variability in DEVOTE: associations with severe hypoglycaemia and cardiovascular outcomes (DEVOTE 2), Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In 13 studies of patients with type 2 diabetes, higher HbA1c variability is associated with higher risk of renal disease (1.34, 1.15 to 1.57), macrovascular events (1.21, 1.06 to 1.38), ulceration/gangrene (1.50, 1.06 to 2.12), cardiovascular disease (1.27, 1.15 to 1.40), and mortality (1.34, 1.18 to 1.53).

    “In the same meta-analysis were included 13 studies of patients with T2D, where higher HbA1c variability was associated with higher risk of renal disease (1.34, 1.15 to 1.57), macrovascular events (1.21, 1.06 to 1.38), ulceration/gangrene (1.50, 1.06 to 2.12), cardiovascular disease (1.27, 1.15 to 1.40), and mortality (1.34, 1.18 to 1.53).20”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source

      Not checked in the free run.

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    Premisecitation

    High HbA1c variability among patients with type 1 diabetes is associated with increased risk of renal disease (risk ratio 1.56, 95% CI 1.08 to 2.25), cardiovascular events (1.98, 1.39 to 2.82), and retinopathy (2.11, 1.54 to 2.89).

    “High HbA1c variability among patients with T1D was associated with increased risk of renal disease (risk ratio 1.56, 95% CI 1.08 to 2.25), cardiovascular events (1.98, 1.39 to 2.82), and retinopathy (2.11, 1.54 to 2.89).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Glycemic variability is positively associated with macrovascular complications and mortality in patients with type 2 diabetes, independently of the HbA1c level.

    “Clinical studies and meta-analyses have shown that GV is positively associated with macrovascular complications and mortality (table 1), independently of the HbA1c level.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Chronic hyperglycemia and exposure of endothelial cells to intermittent high glucose produce overproduction of adhesion molecules such as intracellular adhesion molecule-1, vascular cell adhesion molecule-1, and E-selectin, which regulate leukocyte adhesion to the endothelium and lead to atheroma pathogenesis.

    “In addition, chronic hyperglycemia and exposure of endothelial cells to intermittent high glucose produce an overproduction of several adhesion molecules such as intracellular adhesion molecule-1, vascular cell adhesion molecule-1, and E-selectin, which regulate the adhesion of leukocytes to the endothelium, leading to atheroma pathogenesis.24 38”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 24 38

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with type 2 diabetes at high risk of cardiovascular events in DEVOTE 2, high day-to-day fasting glycemic variability was significantly associated with MACE, with a 1.2-fold increased risk when fasting glycemic variability was duplicated.

    “High day-to-day fasting GV was significantly associated with severe hypoglycemia, MACE and all-cause mortality; risks raised 2.7-fold, 1.2-fold and 1.4-fold, respectively, when fasting GV was duplicated.49”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Zinman, 2018, Day-to-day fasting glycaemic variability in DEVOTE: associations with severe hypoglycaemia and cardiovascular outcomes (DEVOTE 2), Diabetologia source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Diabetes is associated with accelerating atherosclerosis and cardiovascular disease, which accounts for 52% of deaths in patients with type 2 diabetes and 44% in patients with type 1 diabetes.

    “It is also associated with an accelerating atherosclerosis and cardiovascular disease,21 23 34 42 which accounts for 52% of deaths in patients with T2D and 44% in patients T1D.3–5”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites 21 23 34 42

      Not checked in the free run.

    • cites [3] Chan, 2021, The Lancet Commission on diabetes: using data to transform diabetes care and patient lives, Lancet source

      Not checked in the free run.

    • cites [4] Huang, 2017, Macrovascular complications in patients with diabetes and prediabetes, Biomed Res Int

      Not checked in the free run.

    • cites [5] Morrish, 2001, Mortality and causes of death in the who multinational study of vascular disease in diabetes, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The risk of hypoglycemia is increased when the mean blood glucose concentration is low or if deviations around the mean glucose concentration are large.

    “This risk is increased when the mean blood glucose concentration is low or if deviations around the mean glucose concentrations are large, suggesting the need to reduce short-term GV.46”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In DEVOTE 2, glycemic variability was associated with severe hypoglycemia (HR 4.11, 3.15-5.35), MACE (HR 1.36, 1.12-1.65), and all-cause mortality (HR 1.58, 1.23-2.03).

    “GV was associated with severe hypoglycemia: HR 4.11 (3.15–5.35); MACE: HR 1.36 (1.12–1.65); and all cause mortality: HR 1.58 (1.23–2.03).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Zinman, 2018, Day-to-day fasting glycaemic variability in DEVOTE: associations with severe hypoglycaemia and cardiovascular outcomes (DEVOTE 2), Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the HEART2D study, intraday glycemic variability from 7-point self-monitored blood glucose had no difference on cardiovascular outcomes despite reduced intraday glycemic variability and postprandial hyperglycemia.

    “An analysis to assess the effect of intraday GV from 7-point SMBG reported no difference on cardiovascular outcomes despite reduced intraday GV and postprandial hyperglycemia.52”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    During the past three decades, HbA1c has been the main target to assess response to diabetes treatment.

    “During the past three decades, HbA1c, a measure of sustained hyperglycemia, has been the main target to assess response to diabetes treatment”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Poor glycemic control is positively associated with acute and long-term complications of diabetes.
    • Rests on an assumption: Reduction in HbA1c leads to lower rates of diabetic complications.

  • May combine two claims.

    Premisecitation

    In the FLAT-SUGAR trial, despite improvement in glycemic variability, there was no statistically significant difference in cardiac arrhythmias.

    “Despite the improvement in GV, there was no statistically significant difference in cardiac arrhythmias”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The results of experimental and clinical studies demonstrate that glucose fluctuations are associated with oxidative stress, endothelial dysfunction, and inflammation.

    “The results of experimental and clinical studies demonstrate that glucose fluctuations are associated with oxidative stress, endothelial dysfunction, and inflammation”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Minimally invasive continuous glucose monitoring sensors are becoming an increasingly adopted technology for the management of patients with type 1 and type 2 diabetes.

    “minimally invasive CGM sensors are becoming an increasingly adopted technology for the management of patients with T1D and T2D.55”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Rodbard, 2017, Continuous glucose monitoring: a review of recent studies demonstrating improved glycemic outcomes, Diabetes Technol Ther source

      Not checked in the free run.

27 of 27

  • The paper relies on this without support.

    HbA1c is the gold standard for assessment of long-term glycemic control and response to medical treatment in patients with diabetes.

    “Glycated hemoglobin is currently the gold standard for assessment of long-term glycemic control and response to medical treatment in patients with diabetes.”

  • The paper relies on this without support.

    HbA1c does not address fluctuations in blood glucose.

    “Glycated hemoglobin, however, does not address fluctuations in blood glucose.”

  • The paper relies on this without support.

    There is currently no consensus on the use of metrics to assess glycemic variability.

    “There is currently no consensus on the use of metrics to assess GV.”

  • The paper relies on this without support.

    Mechanistic findings from in vitro and animal models of glucose fluctuation apply to the pathogenesis of vascular damage in human type 2 diabetes.

    “In vitro studies in human umbilical vein endothelial cells reported that increases in nitrotyrosine and 8-hydroxydeoxyguanosine, markers of oxidative stress, were more pronounced when they were exposed to intermittent high glucose than in constant high glucose.24”
    “In an animal model, Ying and colleagues41 evaluated markers of tissue oxidative stress in heart ventricles and found that blood glucose fluctuation accelerated cardiac injury via intracellular signal transduction pathways including protein kinase B (AKT), key enzyme in cell death.”

  • The paper relies on this without support.

    Poor glycemic control is positively associated with acute and long-term complications of diabetes.

    “based on the positive association between poor glycemic control and acute and long-term complications of diabetes”

  • The paper relies on this without support.

    Reduction in HbA1c leads to lower rates of diabetic complications.

    “that reduction in HbA1c leads to lower rates in diabetic complications.”
6 of 6

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Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported odds ratio falls outside its interval

    Minor

    The reported odds ratio of 2.21 is outside the accompanying interval, whose endpoints are also in descending order. The Gerbaud result cannot be interpreted as printed.

1 of 1

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Authors
Martinez, M., Santamarina, J., Pavesi, A., Musso, C., & Umpierrez, G. E.
Affiliations
  • Fundacion Favaloro Hospital Universitario (AR)
  • Diabetes and Endocrinology, Favaloro Foundation University Hospital, Buenos Aires, Federal District, Argentina
  • Emory University (US)
Corresponding author
Umpierrez, Guillermo E
ORCID
Venue
BMJ Open Diabetes Research & Care
Publisher
BMJ
Published
2021-03
Volume
9
Issue
1
Pages
e002032
ISSN
2052-4897 (ISSN-L)
DOI
10.1136/bmjdrc-2020-002032
PMC
PMC7993171
OpenAlex
W3138553431
Semantic Scholar
64c8482c3eb134fca5ead0912e1852c256d5243b
Cited by
155
References
58
Citations by year
2026: 23 · 2025: 39 · 2024: 37 · 2023: 32 · 2022: 19 · 2021: 5
FWCI
3.56
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institutes of Health (UL1TR002378)
  • National Center for Advancing Translational Sciences
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, Cardiovascular Risks, and Lipoproteins
Keywords
glycemic variability, type 2 diabetes, cardiovascular disease, HbA1c, continuous glucose monitoring, hypoglycemia, hyperglycemia, microvascular complications, macrovascular complications, mortality
MeSH terms
Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Blood Glucose Self-Monitoring

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