Glycemic Variability: How Do We Measure It and Why Is It Important?
Open accessAbstract
Chronic hyperglycemia is the primary risk factor for the development of complications in diabetes mellitus (DM); however, it is believed that frequent or large glucose fluctuations may independently contribute to diabetes-related complications. Postprandial spikes in blood glucose, as well as hypoglycemic events, are blamed for increased cardiovascular events in DM. Glycemic variability (GV) includes both of these events; hence, minimizing GV can prevent future cardiovascular events. Correcting GV emerges as a target to be pursued in clinical practice to safely reduce the mean blood glucose and to determine its direct effects on vascular complications in diabetes. Modern diabetes management modalities, including glucagon-related peptide-1-based therapy, newer insulins, modern insulin pumps and bariatric surgery, significantly reduce GV. However, defining GV remains a challenge primarily due to the difficulty of measuring it and the lack of consensus regarding the optimal approach for its management. The purpose of this manuscript was not only to review the most recent evidence on GV but also to help readers better understand the available measurement options and how the various definitions relate differently to the development of diabetic complications.
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Most people with prediabetes are unaware that they have this condition.
“most people with prediabetes are unaware that they have this condition3”
From Impact of digital health interventions on glycemic control and weight management. (2025) · cites this paper as [3]
The Glycemic Variability and Diabetes Complications section discusses impaired glucose tolerance and cardiovascular risk, but not whether people with prediabetes know they have it. Searches for prediabetes awareness and undiagnosed impaired glucose tolerance found no passage addressing the claim. (LLM, conf=0.76)
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Cites
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes
(2005) · New England Journal of Medicine · doi:10.1056/nejmoa052187 · Cited by 5,138 · see citing works
Coutinho, M., Gerstein, H. C., Wang, Y., & Yusuf, S. (1999) · Diabetes Care · doi:10.2337/diacare.22.2.233 · Cited by 1,685 · see citing works
Chiasson, J.-L., Josse, R. G., Gomis, R., Hanefeld, M., Karasik, A., Laakso, M., & for The STOP-NIDDM Trial Research Group (2003) · JAMA · doi:10.1001/jama.290.4.486 · Cited by 1,624 · see citing works
Severe hypoglycemia and risks of vascular events and death
Zoungas, S., Patel, A., Chalmers, J., de Galan, B. E., Li, Q., Billot, L., Woodward, M., Ninomiya, T., Neal, B., MacMahon, S., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1003795 · Cited by 1,471 · see citing works
Monnier, L., Lapinski, H., & Colette, C. (2003) · Diabetes Care · doi:10.2337/diacare.26.3.881 · Cited by 1,461 · see citing works
Postprandial Hyperglycemia and Diabetes Complications
Ceriello, A. (2005) · Diabetes · doi:10.2337/diabetes.54.1.1 · Cited by 945 · see citing works
Hypoglycemia in the Diabetes Control and Complications Trial
The Diabetes Control and Complications Trial Research Group (1997) · Diabetes · doi:10.2337/diab.46.2.271 · Cited by 746 · see citing works
Glycemic variability: A strong independent predictor of mortality in critically ill patients.
Krinsley, J. S. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e31818b38d2 · Cited by 729 · see citing works
Cavalot, F., Petrelli, A., Traversa, M., Bonomo, K., Fiora, E., Conti, M., Anfossi, G., Costa, G., & Trovati, M. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-1005 · Cited by 569 · see citing works
Lachin, J. M., Genuth, S., Nathan, D. M., Zinman, B., Rutledge, B. N., & for the DCCT/EDIC Research Group (2008) · Diabetes · doi:10.2337/db07-1618 · Cited by 555 · see citing works
Relationship between glycated haemoglobin levels and mean glucose levels over time
Nathan, D. M., Turgeon, H., & Regan, S. (2007) · Diabetologia · doi:10.1007/s00125-007-0803-0 · Cited by 517 · see citing works
Yeh, H.-C., Brown, T. T., Maruthur, N., Ranasinghe, P., Berger, Z., Suh, Y. D., Wilson, L. M., Haberl, E. B., Brick, J., Bass, E. B., et al. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-157-5-201209040-00508 · Cited by 493 · see citing works
Hyperglycemia and Acute Coronary Syndrome
DEEDWANIA, P. C., Kosiborod, M., Barrett, E. J., Ceriello, A., Isley, W. L., Mazzone, T., & Raskin, P. (2008) · Circulation · doi:10.1161/circulationaha.107.188629 · Cited by 490 · see citing works
Glycemic Variability: A Hemoglobin A<sub>1c</sub>–Independent Risk Factor for Diabetic Complications
Brownlee, M., & Hirsch, I. B. (2006) · JAMA · doi:10.1001/jama.295.14.1707 · Cited by 482 · see citing works
Hypoglycemia, Diabetes, and Cardiovascular Events
Desouza, C. V., Bolli, G. B., & Fonseca, V. A. (2010) · Diabetes Care · doi:10.2337/dc09-2082 · Cited by 440 · see citing works
Intermittent high glucose enhances apoptosis in human umbilical vein endothelial cells in culture
Risso, A., Mercuri, F., Quagliaro, L., Damante, G., & Ceriello, A. (2001) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.2001.281.5.e924 · Cited by 424 · see citing works
Avignon, A., Radauceanu, A., & Monnier, L. (1997) · Diabetes Care · doi:10.2337/diacare.20.12.1822 · Cited by 363 · see citing works
Nalysnyk, L., Hernandez‐Medina, M., & Krishnarajah, G. (2010) · Diabetes, Obesity and Metabolism · doi:10.1111/j.1463-1326.2009.01160.x · Cited by 343 · see citing works
Clinical impact of glycated albumin as another glycemic control marker
Koga, M., & Kasayama, S. (2010) · Endocrine Journal · doi:10.1507/endocrj.k10e-138 · Cited by 290 · see citing works
Monnier, L., & Colette, C. (2008) · Diabetes Care · doi:10.2337/dc08-s241 · Cited by 267 · see citing works
Muggeo, M., Zoppini, G., Bonora, E., Brun, E., Bonadonna, R. C., Moghetti, P., & Verlato, G. (2000) · Diabetes Care · doi:10.2337/diacare.23.1.45 · Cited by 263 · see citing works
Wadén, J., Forsblom, C. M., Thorn, L. M., Gordin, D., Saraheimo, M., Groop, P., & on behalf of the Finnish Diabetic Nephropathy Study Group (2009) · Diabetes · doi:10.2337/db09-0693 · Cited by 238 · see citing works
Glucose Variability: Where It Is Important and How to Measure It
DeVries, J. H. (2013) · Diabetes · doi:10.2337/db12-1610 · Cited by 236 · see citing works
New and Improved Methods to Characterize Glycemic Variability Using Continuous Glucose Monitoring
Rodbard, D. (2009) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2009.0015 · Cited by 230 · see citing works
Service, F. J. (2013) · Diabetes · doi:10.2337/db12-1396 · Cited by 222 · see citing works
Smith‐Palmer, J., Brändle, M., Trevisan, R., Federici, M. O., Liabat, S., & Valentine, W. J. (2014) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2014.06.007 · Cited by 209 · see citing works
Kilpatrick, E. S., Rigby, A. S., Goode, K. M., & Atkin, S. L. (2007) · Diabetologia · doi:10.1007/s00125-007-0820-z · Cited by 208 · see citing works
American Diabetes Association (2015) · Diabetes Care · doi:10.2337/dc15-s009 · Cited by 205 · see citing works
Schiffrin, A., & Belmonte, M. M. (1982) · Diabetes Care · doi:10.2337/diacare.5.5.479 · Cited by 200 · see citing works
Postprandial Hyperglycemia and Glycemic Variability
Standl, E., Schnell, O., & Ceriello, A. (2011) · Diabetes Care · doi:10.2337/dc11-s206 · Cited by 183 · see citing works
Glucose variability: An emerging target for the treatment of diabetes mellitus
Frontoni, S., Bartolo, P. D., Avogaro, A., Bosi, E., Paolisso, G., & Ceriello, A. (2013) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2013.09.007 · Cited by 173 · see citing works
Heinemann, L., Fleming, G. A., Petrie, J. R., Holl, R. W., Bergenstal, R. M., & Peters, A. L. (2015) · Diabetes Care · doi:10.2337/dc15-0168 · Cited by 143 · see citing works
Muggeo, M., Verlato, G., Bonora, E., Zoppini, G., Corbellini, M., & de Marco, R. (1997) · Circulation · doi:10.1161/01.cir.96.6.1750 · Cited by 142 · see citing works
Clinical Interpretation of Indices of Quality of Glycemic Control and Glycemic Variability
Rodbard, D. (2011) · Postgraduate Medicine · doi:10.3810/pgm.2011.07.2310 · Cited by 127 · see citing works
Nontraditional Markers of Glycemia
Selvin, E., Francis, L., Ballantyne, C. M., Hoogeveen, R. C., Coresh, J., Brancati, F. L., & Steffes, M. W. (2011) · Diabetes Care · doi:10.2337/dc10-1945 · Cited by 125 · see citing works
Glucose “peak” and glucose “spike”: Impact on endothelial function and oxidative stress
Ceriello, A., Esposito, K., Piconi, L., Ihnat, M. A., Thorpe, J. E., Testa, R., Bonfigli, A. R., & Giugliano, D. (2008) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2008.07.015 · Cited by 122 · see citing works
1,5-Anhydroglucitol in diabetes mellitus
Kim, W. J., & Park, C. (2012) · Endocrine · doi:10.1007/s12020-012-9760-6 · Cited by 114 · see citing works
Jun, J. E., Jin, S., Baek, J.-H., Oh, S. W., Hur, K. Y., Lee, M., Lee, M., & Kim, J. H. (2015) · Cardiovascular Diabetology · doi:10.1186/s12933-015-0233-0 · Cited by 111 · see citing works
Self-citationBrunner, R., Adelsmayr, G., Herkner, H., Madl, C., & Holzinger, U. (2012) · Critical Care · doi:10.1186/cc11657 · Cited by 101 · see citing works
Wang, C., Lv, L., Yang, Y., Chen, D., Liu, G., Chen, L., Song, Y., He, L., Li, X., Tian, H., et al. (2011) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04205.x · Cited by 94 · see citing works
Cavalot, F. L. (2013) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12140 · Cited by 93 · see citing works
Sartore, G., Chilelli, N. C., Burlina, S., Stefano, P. D., Piarulli, F., Fedele, D., Mosca, A., & Lapolla, A. (2012) · Acta Diabetologica · doi:10.1007/s00592-012-0391-4 · Cited by 90 · see citing works
Siegelaar, S. E., Kerr, L., Jacober, S. J., & Devries, J. H. (2011) · Diabetes Care · doi:10.2337/dc10-1684 · Cited by 89 · see citing works
Salardi, S., Zucchini, S., Santoni, R., Ragni, L., Gualandi, S. C., Cicognani, A., & CACCIARI, E. (2002) · Diabetes Care · doi:10.2337/diacare.25.10.1840 · Cited by 87 · see citing works
New Indices for Predicting Glycaemic Variability
Ogawa, A., Hayashi, A., Kishihara, E., Yoshino, S., Takeuchi, A., & Shichiri, M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0046517 · Cited by 86 · see citing works
Glycemic variability and diabetes retinopathy: A missing link
Hsu, C.-R., Chen, Y., & Sheu, W. H. (2014) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2014.11.013 · Cited by 83 · see citing works
Ayano‐Takahara, S., Ikeda, K., Fujimoto, S., et al. (2014) · Diabetes Care · doi:10.2337/dc14-1801 · Cited by 83 · see citing works
Heinemann, L., Fleming, G. A., Petrie, J. R., Holl, R. W., Bergenstal, R. M., & Peters, A. L. (2015) · Diabetologia · doi:10.1007/s00125-015-3513-z · Cited by 82 · see citing works
Glycemic variability: Clinical implications
Kota, S., Krishna, S. S., & Modi, K. D. (2013) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.113751 · Cited by 75 · see citing works
Lee, E. Y., Lee, B., Kim, D., Lee, Y., Kim, K. J., Kang, E. S., Soo, B., Lee, E. J., & Lee, H. C. (2010) · Acta Diabetologica · doi:10.1007/s00592-010-0242-0 · Cited by 75 · see citing works
Jin, S.-M., Kim, T.-H., Bae, J. C., Hur, K. Y., Lee, M.-S., Lee, M.-K., & Kim, J. H. (2014) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2014.02.003 · Cited by 74 · see citing works
Self-citationRodbard, D. (2007) · Journal of Diabetes Science and Technology · doi:10.1177/193229680700100111 · Cited by 74 · see citing works
Clinical use of insulin degludec
Vora, J. P., Cariou, B., Evans, M., Gross, J. L., Harris, S. B., Landstedt‐Hallin, L., Mithal, A., Rodriguez, M. R., & Meneghini, L. (2015) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2015.04.002 · Cited by 73 · see citing works
van Haeften, T. W., Pimenta, W. P., Mitrakou, A., Korytkowski, M., Jenssen, T. G., Yki‐Järvinen, H., & Gerich, J. E. (2000) · Metabolism · doi:10.1053/meta.2000.9526 · Cited by 71 · see citing works
Jeha, G. S., Karaviti, L. P., Anderson, B. J., Smith, E., Donaldson, S., McGirk, T. S., & Haymond, M. W. (2005) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2005.7.876 · Cited by 67 · see citing works
Therapy Insight: the effect of tight glycemic control in acute illness
Langouche, L., Vanhorebeek, I., & den Berghe, G. V. (2007) · Nature Clinical Practice Endocrinology & Metabolism · doi:10.1038/ncpendmet0426 · Cited by 62 · see citing works
Heinemann, L., Zijlstra, E., Pleus, S., & Freckmann, G. (2015) · Diabetes Care · doi:10.2337/dc15-0817 · Cited by 49 · see citing works
Baghurst, P., Rodbard, D., & Cameron, F. (2010) · Journal of Diabetes Science and Technology · doi:10.1177/193229681000400612 · Cited by 46 · see citing works
Seok, H., Huh, J. H., Kim, H. M., Lee, B., Kang, E. S., Lee, H. C., & Soo, B. (2015) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2015.39.2.164 · Cited by 39 · see citing works
1,5-Anhydroglucitol and Glycated Albumin in Glycemia
Koga, M. (2014) · Advances in clinical chemistry · doi:10.1016/b978-0-12-800263-6.00007-0 · Cited by 39 · see citing works
Jin, S., Kim, T., Oh, S. W., Baek, J. Y., Joung, J. Y., Park, S. M., Cho, Y. Y., Sohn, S. Y., Hur, K. Y., Lee, M. ‐., et al. (2014) · Diabetic Medicine · doi:10.1111/dme.12607 · Cited by 35 · see citing works
Self-citationSuh, S., Joung, J. Y., Jin, S., Kim, M. Y., Bae, J., PARK, H., Lee, M. S., Lee, M. K., & Kim, J. H. (2014) · Diabetes & Metabolism · doi:10.1016/j.diabet.2014.01.006 · Cited by 31 · see citing works
Self-citationHow can we monitor glycaemic variability in the clinical setting?
Inchiostro, S., Candido, R., & Cavalot, F. L. (2013) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12142 · Cited by 29 · see citing works
Kim, S. K., Kim, H. J., Kim, T., Hur, K. Y., Kim, S. W., Lee, M.-K., Min, Y.-K., Kim, K.-W., Chung, J. H., & Kim, J. H. (2014) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2014.38.6.449 · Cited by 23 · see citing works
Self-citationKim, S. Y., Suh, S., Kim, M. Y., Chung, H. S., Hur, K. Y., Kim, S. W., Chung, J. H., Lee, M., Min, Y., Kim, K., et al. (2011) · Endocrine Journal · doi:10.1507/endocrj.k10e-378 · Cited by 19 · see citing works
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Sun, B., Luo, Z., & Zhou, J. (2021) · Cardiovascular Diabetology · doi:10.1186/s12933-020-01200-7 · Cited by 168 · see citing works
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Šoupal, J., Petruželková, L., Flekač, M., Pelcl, T., Matoulek, M., Daňková, M., Škrha, J., Svačina, Š., & Prázný, M. (2016) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.0171 · Cited by 126 · see citing works
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- Authors
- Suh, S., & Kim, J. H.
- Affiliations
- Dong-A University Hospital (KR)
- Samsung Medical Center (KR)
- Corresponding author
- Kim, Jae Hyeon
- Venue
- Diabetes & Metabolism Journal
- Publisher
- Korean Diabetes Association
- Published
- 2015
- Volume
- 39
- Issue
- 4
- Pages
- 273
- ISSN
- 2233-6079 (ISSN-L)
- 2233-6087
- PMC
- PMC4543190
- OpenAlex
- W1872244446
- Cited by
- 439
- References
- 65
- Citations by year
- 2026: 46 · 2025: 45 · 2024: 51 · 2023: 38 · 2022: 38 · 2021: 53 · 2020: 50 · 2019: 42 · 2018: 38 · 2017: 21 · 2016: 16 · 2015: 1
- FWCI
- 3.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Diabetes & Metabolism Journal (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, diabetes mellitus, postprandial hyperglycemia, hypoglycemia, cardiovascular risk, diabetes complications, GLP-1 receptor agonists, insulin pump, bariatric surgery, glycemic control
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