J Korean Diabetes.  2022 Mar;23(1):12-20. 10.4093/jkd.2022.23.1.12.

Glycemic Variability and Diabetes Mellitus

• Jang HN
• Jung HS

• KMID: 2528406
• DOI: http://doi.org/10.4093/jkd.2022.23.1.12

Abstract

Not only mean blood glucose, but also ‘glycemic variability,’ the degree of fluctuation in blood glucose, has been suggested to contribute to diabetic complications. Glycemic variability can be expressed with various indices, such as standard deviation, coefficient of variation (CV), mean amplitude of glycemic excursion, etc.; however, standard indicators have not been established. Recently, CV was designated in cases of application of continuous glucose monitoring system according to international consensus. In this review, clinical implications of glycemic variability are dealt with respect to micro- and macrovascular complications of diabetes, and clinical evidence of new anti-diabetics are summarized about efficacy on the glycemic variability.

Keyword

Diabetes mellitus; Diabetic complications; Glycemic variability

Figure

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  Fig. 1. Blood glucose curves and glycemic variability in 2 patients with diabetes. Glycemic variability is determined by amplitude of the change in blood glucose level and the time required for the change. Blood glucose curves of 2 patients for 24 hours are depicted by red and blue lines, respectively. They demonstrated different patterns of glycemic variability with the same average glucose. Standard deviation calculated from 4 glucose measurements before every meal and before bedtime (arrows) would not accurately reflect the difference in glycemic variability between the 2 patients. An area under the curve (AUC) higher than 180 mg/dL calculated from a continuous glucose monitoring system can represent postprandial hyperglycemia. Modified from the article of Jung (Endocrinol Metab (Seoul) 2015;30:167-74) [3] under the Creative Commons Attribution Non-Commercial (CC BY-NC 3.0) license.

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  Fig. 2. Glycemic variability and diabetes mellitus. CGMS, continuous glucose monitoring system; MAGE, mean amplitude of glycemic excursion.

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