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

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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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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: Monnier, Louis
Wojtusciszyn, Anne
Molinari, Nicolas
Owens, David R.
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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Toward Defining the Threshold Between Low and High Glucose Variability in Diabetes

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