Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature

Aim: The objective of this review was to assess the published evidence for an association between glycaemic variability and the development of chronic micro- and macrovascular complications in patients with diabetes mellitus (DM). Methods: A systematic review of English-language literature published...

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Veröffentlicht in:Diabetes, obesity & metabolism obesity & metabolism, 2010-04, Vol.12 (4), p.288-298
Hauptverfasser: Nalysnyk, L, Hernandez-Medina, M, Krishnarajah, G
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container_title Diabetes, obesity & metabolism
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creator Nalysnyk, L
Hernandez-Medina, M
Krishnarajah, G
description Aim: The objective of this review was to assess the published evidence for an association between glycaemic variability and the development of chronic micro- and macrovascular complications in patients with diabetes mellitus (DM). Methods: A systematic review of English-language literature published from January 1990 through November 2008 was performed. Interventional and observational studies in patients with type 1 or type 2 DM reporting a measure of glycaemic variability and its impact on the development or progression of micro- and macrovascular diabetic complications were assessed. Results: A total of 18 studies -8 on type 1 DM and 10 on type 2 DM patients-meeting the inclusion criteria were identified. Studies in patients with type 1 DM revealed that glucose variability has little impact on the development of diabetic complications. Only in two of the eight type 1 DM studies did glucose variability have a significant association with microvascular complications, but not with macrovascular complications. Among type 2 DM studies, a significant positive association between glucose variability and the development or progression of diabetic retinopathy, cardiovascular events and mortality was reported in 9 of 10 studies. Only one type 2 DM study reported no association between glucose variability and progression of retinopathy. Conclusions: Based on this overview of the available evidence, there appears to be a signal suggesting that glucose variability, characterized by extreme glucose excursions, could be a predictor of diabetic complications, independent of HbA1c levels, in patients with type 2 DM. Better daily control of blood glucose excursions, especially in the postprandial period, may reduce the risk of these complications. Future prospective trials evaluating and comparing the effect of the control of glycaemic variability on the development of diabetic micro- and macrovascular complications are needed to further strengthen the evidence base.
doi_str_mv 10.1111/j.1463-1326.2009.01160.x
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Methods: A systematic review of English-language literature published from January 1990 through November 2008 was performed. Interventional and observational studies in patients with type 1 or type 2 DM reporting a measure of glycaemic variability and its impact on the development or progression of micro- and macrovascular diabetic complications were assessed. Results: A total of 18 studies -8 on type 1 DM and 10 on type 2 DM patients-meeting the inclusion criteria were identified. Studies in patients with type 1 DM revealed that glucose variability has little impact on the development of diabetic complications. Only in two of the eight type 1 DM studies did glucose variability have a significant association with microvascular complications, but not with macrovascular complications. Among type 2 DM studies, a significant positive association between glucose variability and the development or progression of diabetic retinopathy, cardiovascular events and mortality was reported in 9 of 10 studies. Only one type 2 DM study reported no association between glucose variability and progression of retinopathy. Conclusions: Based on this overview of the available evidence, there appears to be a signal suggesting that glucose variability, characterized by extreme glucose excursions, could be a predictor of diabetic complications, independent of HbA1c levels, in patients with type 2 DM. Better daily control of blood glucose excursions, especially in the postprandial period, may reduce the risk of these complications. Future prospective trials evaluating and comparing the effect of the control of glycaemic variability on the development of diabetic micro- and macrovascular complications are needed to further strengthen the evidence base.</description><identifier>ISSN: 1462-8902</identifier><identifier>EISSN: 1463-1326</identifier><identifier>DOI: 10.1111/j.1463-1326.2009.01160.x</identifier><identifier>PMID: 20380649</identifier><language>eng</language><publisher>Oxford, UK: Oxford, UK : Blackwell Publishing Ltd</publisher><subject>Blood Glucose - metabolism ; Cardiovascular diseases ; Clinical trials ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 1 - complications ; Diabetes Mellitus, Type 1 - metabolism ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - metabolism ; Diabetic Angiopathies - etiology ; diabetic complications ; Evidence-Based Medicine ; Female ; Glucose ; glycaemic variability ; Humans ; Hyperglycemia - complications ; Literature reviews ; Male ; Microvasculature ; Retinopathy ; Risk Factors ; Systematic review ; Variability</subject><ispartof>Diabetes, obesity &amp; metabolism, 2010-04, Vol.12 (4), p.288-298</ispartof><rights>2010 Blackwell Publishing Ltd</rights><rights>Copyright Wiley Subscription Services, Inc. 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Methods: A systematic review of English-language literature published from January 1990 through November 2008 was performed. Interventional and observational studies in patients with type 1 or type 2 DM reporting a measure of glycaemic variability and its impact on the development or progression of micro- and macrovascular diabetic complications were assessed. Results: A total of 18 studies -8 on type 1 DM and 10 on type 2 DM patients-meeting the inclusion criteria were identified. Studies in patients with type 1 DM revealed that glucose variability has little impact on the development of diabetic complications. Only in two of the eight type 1 DM studies did glucose variability have a significant association with microvascular complications, but not with macrovascular complications. Among type 2 DM studies, a significant positive association between glucose variability and the development or progression of diabetic retinopathy, cardiovascular events and mortality was reported in 9 of 10 studies. Only one type 2 DM study reported no association between glucose variability and progression of retinopathy. Conclusions: Based on this overview of the available evidence, there appears to be a signal suggesting that glucose variability, characterized by extreme glucose excursions, could be a predictor of diabetic complications, independent of HbA1c levels, in patients with type 2 DM. Better daily control of blood glucose excursions, especially in the postprandial period, may reduce the risk of these complications. Future prospective trials evaluating and comparing the effect of the control of glycaemic variability on the development of diabetic micro- and macrovascular complications are needed to further strengthen the evidence base.</description><subject>Blood Glucose - metabolism</subject><subject>Cardiovascular diseases</subject><subject>Clinical trials</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus, Type 1 - complications</subject><subject>Diabetes Mellitus, Type 1 - metabolism</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - metabolism</subject><subject>Diabetic Angiopathies - etiology</subject><subject>diabetic complications</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Glucose</subject><subject>glycaemic variability</subject><subject>Humans</subject><subject>Hyperglycemia - complications</subject><subject>Literature reviews</subject><subject>Male</subject><subject>Microvasculature</subject><subject>Retinopathy</subject><subject>Risk Factors</subject><subject>Systematic review</subject><subject>Variability</subject><issn>1462-8902</issn><issn>1463-1326</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1v1DAQhiMEoqXwF8ASB04JYzvr2EgcqgJbUEsPpdqj5XUm1Es-Fjvpbk78dZym7IEL-DIjzfP660kSQiGjcb3dZDQXPKWciYwBqAwoFZDtHyXHh8Hj-56lUgE7Sp6FsAGAnMviaXLEgEsQuTpOfi3r0RpsnCV3xjuzdrXrR2Laktiu2dbOmt51bSCuJdvYYtsHsnP9LSkjjD0G0mAdM0N4R_DOldhaJJXvGmJIGEOPTUxZ4uMMd6SrSH-LJPLoTT94fJ48qUwd8MVDPUluPn38dnaeXlwtP5-dXqQ2VwAp5sJQRUuj0NrC5iUFKSul1muqOKsKU_FYDS2R4QIBRYFoJBOsYhESa36SvJn33fru54Ch140LNt7ctNgNQRe5AKCiyP9N8viHQBmL5Ou_yE03-DY-Q3NYqByUKGSk5ExZ34XgsdJb7xrjR01BTzb1Rk_S9CRNTzb1vU29j9GXDwcM6wbLQ_CPvgi8n4Gdq3H87431h6vLqYv5dM67KGp_yBv_Q4uCFwu9-rrUl6vF9Up-Odc88q9mvjKdNt-9C_rmmgHlQCUUuaT8N_qyx7U</recordid><startdate>201004</startdate><enddate>201004</enddate><creator>Nalysnyk, L</creator><creator>Hernandez-Medina, M</creator><creator>Krishnarajah, G</creator><general>Oxford, UK : Blackwell Publishing Ltd</general><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>FBQ</scope><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>201004</creationdate><title>Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature</title><author>Nalysnyk, L ; 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subjects Blood Glucose - metabolism
Cardiovascular diseases
Clinical trials
Diabetes
Diabetes mellitus
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 1 - metabolism
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - metabolism
Diabetic Angiopathies - etiology
diabetic complications
Evidence-Based Medicine
Female
Glucose
glycaemic variability
Humans
Hyperglycemia - complications
Literature reviews
Male
Microvasculature
Retinopathy
Risk Factors
Systematic review
Variability
title Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature
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