Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Dec;21(12):2599-2608.
doi: 10.1111/dom.13842. Epub 2019 Aug 26.

Glycaemic variability: The under-recognized therapeutic target in type 1 diabetes care

Emma G Wilmot  1   2 , Pratik Choudhary  3 , Lalantha Leelarathna  4   5 , Mike Baxter  6   7
Affiliations
Review

Glycaemic variability: The under-recognized therapeutic target in type 1 diabetes care

Emma G Wilmot et al. Diabetes Obes Metab. 2019 Dec.

Abstract

Type 1 diabetes mellitus (T1DM) remains one of the most challenging long-term conditions to manage. Despite robust evidence to demonstrate that near normoglycaemia minimizes, but does not completely eliminate, the risk of complications, its achievement has proved almost impossible in a real-world setting. HbA1c to date has been used as the gold standard marker of glucose control and has been shown to reflect directly the risk of diabetes complications. However, it has been recognized that HbA1c is a crude marker of glucose control. Continuous glucose monitoring (CGM) provides the ability to measure and observe inter- and intraday glycaemic variability (GV), a more meaningful measure of glycaemic control, more relevant to daily living for those with T1DM. This paper reviews the relationship between GV and hypoglycaemia, and micro- and macrovascular complications. It also explores the impact on GV of CGM, insulin pumps, closed-loop technologies, and newer insulins and adjunctive therapies. Looking to the future, there is an argument that GV should become a key determinant of therapeutic success. Further studies are required to investigate the pathological and psychological benefits of reducing GV.

Keywords: continuous glucose monitoring; glycaemic variability; type 1 diabetes mellitus.

PubMed Disclaimer

Conflict of interest statement

E. G. W. has received personal fees from Abbott Diabetes Care, Dexcom, Diasend/Glooko, Eli Lilly, Medtronic, Novo Nordisk and Sanofi Aventis. P. C. has received personal fees from AstraZeneca, Dexcom, Lilly Diabetes, Medtronic, Novo Nordisk, Roche Diabetes Care and Sanofi Aventis. L. L. has received speaker honoraria from Abbott, Animas, Insulet, Medtronic, Novo Nordisk, Roche and Sanofi; advisory board fees from Abbott, Animas, Dexcom, Medtronic, Novo Nordisk, Roche and Sanofi research; and support from Dexcom and Novo Nordisk. M. B. is an employee of Sanofi.

References

    1. Nathan DM, Genuth S, Lachin J, et al. The effect of intensive treatment of diabetes on the development and progression of long‐term complications in insulin‐dependent diabetes mellitus. N Engl J Med. 1993;329:977‐986. - PubMed
    1. Nathan DM. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care. 2014;37:9‐16. - PMC - PubMed
    1. Simmons JH, Chen V, Miller KM, et al. Differences in the management of type 1 diabetes among adults under excellent control compared with those under poor control in the T1D Exchange Clinic Registry. Diabetes Care. 2013;36:3573‐3577. - PMC - PubMed
    1. American Diabetes Association . 6. Glycemic targets: standards of medical care in diabetes‐2018. Diabetes Care. 2018;41:S55‐S64. - PubMed
    1. Juvenile Diabetes Research Foundation Ltd (JDRF) . Type 1 diabetes facts and figures. 2018. https://jdrf.org.uk/information-support/about-type-1-diabetes/facts-and-.... Accessed January 17, 2019.

Publication types

MeSH terms