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Abstract
Chronic hyperglycemia is the main risk factor for the development of diabetes-related complications in diabetes mellitus (DM). Glycated hemoglobin (HbA1c) is used to estimate the risk of developing diabetic complications, to define targets, and to measure the efficacy of diabetes treatments. Up until recently, it has been thought that frequent or large glucose fluctuations may contribute independently to diabetes-related complications. However, diabetes-related glycemic alterations are now understood in more complex terms, through studies attempting to identify the role of fasting glycemia, postprandial glycemia, and hypoglycemia in the overall assessment of the disease. This set of evaluations has led to the concept of glucose variability (GV). Postprandial spikes in blood glucose as well as hypoglycemic events, both are implicated in increased cardiovascular events in DM. GV includes both of these events; thus, minimizing GV can prevent future cardiovascular events. For these reasons, correcting GV has emerged as an important goal in clinical practice in order to safely reduce mean blood glucose (and thus HbA1c) and for its direct effects on vascular complications of DM. However, the literature available on glucose GV is extensive but confusing. This article highlights the most recent evidence, clinical implications, and measures to control GV in clinical practice.
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Table 1.
Mechanisms involving glucose variability and cardiovascular risk
Table 2.
Postprandial glucose and glucose variability indices
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