Minimizing Glycemic Fluctuations in Patients with Type 2 Diabetes: Approaches and Importance

Abstract

Glycemic fluctuations, characterized by short-term oscillations in plasma glucose, are important when managing type 2 diabetes (T2D) and may be considered a target of glucose-lowering therapies. Continuous glucose monitoring (CGM) has been used to evaluate the effects of different treatments on glycemic fluctuations. This review examines approaches to and the importance of minimizing glycemic fluctuations among patients with T2D. Measures of HbA_1c, fructosamine, and glycated albumin reflect a long-term average of plasma glucose, and are therefore unable to provide an accurate measure of short-term glycemic oscillations. CGM provides accurate monitoring of real-time glucose fluctuations and has been used to investigate the effects of lifestyle and treatment on daily glycemic control. Dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists have demonstrated significant improvements in measures such as the mean amplitude of glucose excursions and standard deviation of CGM. Case studies of two patients with T2D utilizing CGM are also included in this review, which demonstrated that CGM was a useful tool for diagnosing unrecognized hypoglycemia and hyperglycemia in situations in which it was impractical to check fingerstick concentrations. Altogether, the evidence suggests that glycemic fluctuations are a potential target to consider when managing T2D. CGM allows for the real-time evaluation of glycemic fluctuations and may assist in the development of an individualized treatment plan to adequately control short-term oscillations in blood glucose levels.

Keywords: Glucose; Glycemic control; Glycemic fluctuations; Glycemic variability; Type 2 diabetes.

FIG. 1.

Change from baseline in mean 24-h glucose profiles at weeks 4 and 10 (exenatide QW + MET, n = 60; placebo + MET, n = 56). Light blue line = exenatide QW + MET at week 4; navy blue line = exenatide QW + MET at week 10; light pink line = placebo + MET at week 4; magenta line = placebo + MET at week 10. MET, metformin; QW, once weekly. Reproduced with permission from Frías et al.