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Cited by 390Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

Toward Defining the Threshold Between Low and High Glucose Variability in Diabetes

Monnier, Louis, Colette, Claude, Wojtusciszyn, Anne, Dejager, Sylvie, Renard, Eric, Molinari, Nicolas, Owens, David R.·2017·Diabetes Care
DOI 10.2337/dc16-1769
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Abstract

OBJECTIVE: To define the threshold for excess glucose variability (GV), one of the main features of dysglycemia in diabetes. RESEARCH DESIGN AND METHODS: A total of 376 persons with diabetes investigated at the University Hospital of Montpellier (Montpellier, France) underwent continuous glucose monitoring. Participants with type 2 diabetes were divided into several groups—groups 1, 2a, 2b, and 3 (n = 82, 28, 65, and 79, respectively)—according to treatment: 1) diet and/or insulin sensitizers alone; 2) oral therapy including an insulinotropic agent, dipeptidyl peptidase 4 inhibitors (group 2a) or sulfonylureas (group 2b); or 3) insulin. Group 4 included 122 persons with type 1 diabetes. Percentage coefficient of variation for glucose (%CV = [(SD of glucose)/(mean glucose)] × 100) and frequencies of hypoglycemia (interstitial glucose <56 mg/dL [3.1 mmol/L]) were computed. RESULTS: Percentages of CV (median [interquartile range]; %) increased significantly (P < 0.0001) from group 1 (18.1 [15.2–23.9]) to group 4 (37.2 [31.0–42.3]). In group 1, the upper limit of %CV, which served as reference for defining excess GV, was 36%. Percentages of patients with %CVs above this threshold in groups 2a, 2b, 3, and 4 were 0, 12.3, 19.0, and 55.7%, respectively. Hypoglycemia was more frequent in group 2b (P < 0.01) and groups 3 and 4 (P < 0.0001) when subjects with a %CV >36% were compared with those with %CV ≤36%. CONCLUSIONS: A %CV of 36% appears to be a suitable threshold to distinguish between stable and unstable glycemia in diabetes because beyond this limit, the frequency of hypoglycemia is significantly increased, especially in insulin-treated subjects.

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  • In a mixed population of people with type 2 diabetes, the incidence of hypoglycemic events was three to six times greater in patients with a within-day CV of more than 36% compared with a CV less than 36%, irrespective of treatment with oral diabetes drugs or insulin.

    “In a mixed population of people with T2D, the incidence of hypoglycemic events was three to six times greater in patients with a within-day CV of more than 36% compared with a CV less than 36%, irrespective of the type of treatment with oral diabetes drugs or insulin.47”

    From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [47]

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Authors
Monnier, L., Colette, C., Wojtusciszyn, A., Dejager, S., Renard, E., Molinari, N., & Owens, D. R.
Affiliations
  • Université de Montpellier (FR)
  • Pitié-Salpêtrière Hospital (FR)
  • Department of Endocrinology, Diabetes, and Nutrition, Montpellier University Hospital, University of Montpellier, Montpellier, France
  • Swansea University (GB)
Corresponding author
Monnier, Louis
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2016-12-30
Volume
40
Issue
7
Pages
832-838
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc16-1769
OpenAlex
W2566952971
Cited by
390
References
40
Citations by year
2026: 25 · 2025: 41 · 2024: 45 · 2023: 39 · 2022: 48 · 2021: 53 · 2020: 44 · 2019: 44 · 2018: 33 · 2017: 17
FWCI
31.40
Type
journal article
Language
en
Open access
closed
Licence
www.diabetesjournals.org/content/license (vor, 173 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
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, type 1 diabetes, coefficient of variation, hypoglycemia, continuous glucose monitoring, insulin therapy, DPP-4 inhibitors, sulfonylureas, insulin sensitizers, glycemic stability, threshold
MeSH terms
Aged, Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Sulfonylurea Compounds, Treatment Outcome, Dipeptidyl-Peptidase IV Inhibitors

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