Glucose Variability and Tight Glycemic Control

When it comes to glucose control, glucose variability, and the risk for hypoglycemia, often times they can be related. Even though reducing hyperglycemia and leveling HbA1c values of seven percent or less result in decreased risk of complications, the risk for hypoglycemia increases when glycemic control is tightened. Thus, hypoglycemia has been viewed as the barricade to tight glycemic control. Because of this, patients with diabetes face the ultimate problem: reducing average glycemic levels and hyperglycemia following meals, while at the same time, trying to avoid hypoglycemia.

What is the strategy behind achieving optimization?

The strategy can only be successful if it reduces glucose variability. Bringing the average glycemia down is only attainable if glucose variability is restrained. If glucose variability is not restrained, blood glucose variations would unavoidably enter hypoglycemia.

How can glucose variability be measured?

There are different ways to monitor glucose and each direction results in different determinations of glucose variability.

1. HbA1C measuring, which captures only slow fluctuations in average glycemia and takes place over several months.
2. Self-monitoring of blood glucose a few times a day, which captures daily variations in blood glucose.
3. Contemporary continuous glucose monitoring, which takes the glucose variability monitoring resolution to the scale in a matter of minutes.

What are the causes of glucose variability?

Blood glucose variations in type 1 diabetes result from other organs in the body, including: the gut, liver, pancreas, and brain. Every patient’s organs react differently, and the ability of these organs to metabolize glucose are what determine the stability of the patient’s glycemic control. The principal components of glucose variability revolve around amplitude and timing.

While managing diabetes is extremely difficult, it is all about optimization and finding the balance. The tradeoff is between frequency of hypoglycemia and HbA1C, which reflects the average blood glucose level and is mainly driven by the duration and extent of hyperglycemia. Even though glucose variability has stronger content than the average glucose of HbA1C, glucose variability depends on the factors of amplitude and timing, which leads to the critical importance of tight glycemic control.