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Cited by 140Diabetes Management and ResearchDiabetes Treatment and ManagementHyperglycemia and glycemic control in critically ill and hospitalized patients

Glycemic variability and diabetes complications: does it matter? Simply put, there are better glycemic markers!

Bergenstal, Richard M.·2015·Diabetes Care
DOI 10.2337/dc15-0099
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Abstract

There is no argument that improving mean levels of glycemic control as judged by assays for glycated hemoglobin (HbA1c) reduces the risks of microvascular complications and cardiovascular disease events in patients with type 1 and type 2 diabetes. However, observations in some trials have suggested that targeting HbA1c to suggested targets may not always result in improved outcomes for people with long-standing type 2 diabetes. The reasons why the glycemic control strategies that primarily use HbA1c in these studies did not have predicted outcomes are not clear. Thus, controversy remains as to whether there are glycemic metrics beyond HbA1c that can be defined as effective measures that can be used in addition to HbA1c to help in assessing the risk of an individual developing diabetes complications. In this regard, the concept of “glycemic variability” (GV) is one metric that has attracted a lot of attention. GV can be simply defined as the degree to which a patient’s blood glucose level fluctuates between high (peaks) and low (nadir) levels. The best and most precise way to assess GV is also one that is still debated. Thus, while there is universal agreement that HbA1c is the current gold standard for the primary clinical target, there is no consensus as to whether other proposed glycemic metrics hold promise to provide additional clinical data or whether there should be additional targets beyond HbA1c. Therefore, given the current controversy, we provide a Point-Counterpoint debate on this issue. In the preceding point narrative, Dr. Hirsch provides his argument that fluctuations in blood glucose as assessed by GV metrics are deleterious and control of GV should be a primary treatment target. In the counterpoint narrative below, Dr. Bergenstal argues that there are better markers to assess the risk of diabetes than GV and provides his consideration of other concepts. —William T. Cefalu Editor in Chief, Diabetes Care

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  • Variability in glucose concentrations and glycosylation rates probably contribute to interindividual differences in complications.

    “Variability in glucose concentrations (both during the day and longer term) and glycosylation rates also probably have a role in interindividual differences.115,116”

    From Type 1 diabetes (2018) · cites this paper as [115]

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Authors
Bergenstal, R. M.
Affiliations
Park Nicollet Health Services (US)
Corresponding author
Bergenstal, Richard M.
ORCID
Bergenstal, Richard M.
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2015-07-14
Volume
38
Issue
8
Pages
1615-1621
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc15-0099
OpenAlex
W1930530978
Cited by
140
References
40
Citations by year
2026: 2 · 2025: 5 · 2024: 11 · 2023: 7 · 2022: 6 · 2021: 22 · 2020: 18 · 2019: 17 · 2018: 15 · 2017: 23 · 2016: 12 · 2015: 2
FWCI
15.07
Type
journal article
Language
en
Open access
closed
Licence
www.diabetesjournals.org/site/license (vor, 202 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
Leona M. and Harry B. Helmsley Charitable Trust
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 › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords
glycemic variability, glycemic control, HbA1c, type 2 diabetes, type 1 diabetes, diabetes complications, microvascular complications, cardiovascular risk, glycemic markers, blood glucose fluctuation, glycemic targets
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Glycated Hemoglobin, Humans, Hypoglycemia, Biomarkers, Diabetes Complications, Microvessels

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