Internal Medicine and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, Turin, Italy.
Diabetes Obes Metab. 2013 Sep;15 Suppl 2:3-8. doi: 10.1111/dom.12140.
In recent years glycaemic variability (GV) has emerged as a determinant of vascular complications of both type 1 and type 2 diabetes mellitus. In type 1 diabetes analysis of data of GV show conflicting results on both micro- and macro-vascular complications. In non-diabetic subjects blood glucose after loading is a stronger predictor of cardiovascular complications than fasting glucose. In type 2 diabetes both coefficient of variation of fasting blood glucose and postprandial blood glucose predict cardiovascular events. Also, long term variability of HbA1c has been associated predominantly with diabetic nephropathy, less frequently with retinopathy. Intervention trials to evaluate the effect of postprandial glucose have been conducted only in prediabetes or in type 2 diabetes and the data are not conclusive. In vitro and in vivo data have shown the mechanisms that are at the basis of the adverse cardiovascular effects of GV, mainly associated with oxidative stress; the atherogenic action of postprandial glucose also involves insulin sensitivity, postprandial increase in serum lipids and glycaemic index of food. Thus, correction of GV emerges as a target to be pursued in clinical practice in order to safely reduce mean blood glucose (and thus glycated haemoglobin) and for its direct effects on vascular complications of diabetes.
近年来，血糖变异性（GV）已成为 1 型和 2 型糖尿病血管并发症的决定因素。在 1 型糖尿病中，GV 的数据分析结果在微血管和大血管并发症方面存在相互矛盾的结果。在非糖尿病患者中，餐后血糖比空腹血糖更能预测心血管并发症。在 2 型糖尿病中，空腹血糖和餐后血糖的变异系数均可预测心血管事件。此外，HbA1c 的长期变异性主要与糖尿病肾病相关，与视网膜病变的相关性较小。评估餐后血糖影响的干预试验仅在糖尿病前期或 2 型糖尿病中进行，且数据尚无定论。体外和体内数据表明了 GV 对心血管产生不良影响的机制，主要与氧化应激有关；餐后血糖的动脉粥样硬化作用还涉及胰岛素敏感性、餐后血清脂质增加和食物的血糖指数。因此，校正 GV 成为临床实践中需要追求的目标，以安全地降低平均血糖（从而降低糖化血红蛋白），并直接降低糖尿病血管并发症的风险。
