Jangam Sujit R, Hayter Gary, Dunn Timothy C
Research and Development, Abbott Diabetes Care Inc., Alameda, CA, USA.
Diabetes Ther. 2018 Feb;9(1):395-402. doi: 10.1007/s13300-017-0340-x. Epub 2017 Nov 21.
Glycemic variability refers to oscillations in blood glucose within a day and differences in blood glucose at the same time on different days. Glycemic variability is linked to hypoglycemia and hyperglycemia. The relationship among these three important metrics is examined here, specifically to show how reduction in both hypo- and hyperglycemia risk is dependent on changes in variability.
To understand the importance of glycemic variability in the simultaneous reduction of hypoglycemia and hyperglycemia risk, we introduce the glycemic risk plot-estimated HbA1c % (eA1c) vs. minutes below 70 mg/dl (MB70) with constant variability contours for predicting post-intervention risks in the absence of a change in glycemic variability.
The glycemic risk plot illustrates that individuals who do not reduce glycemic variability improve one of the two metrics (hypoglycemia risk or hyperglycemia risk) at the cost of the other. It is important to reduce variability to improve both risks. These results were confirmed by data collected in a randomized controlled trial consisting of individuals with type 1 and type 2 diabetes on insulin therapy. For type 1, a total of 28 individuals out of 35 (80%) showed improvement in at least one of the risks (hypo and/or hyper) during the 100-day course of the study. Seven individuals (20%) showed improvement in both. Similar data were observed for type 2 where a total of 36 individuals out of 43 (84%) showed improvement in at least one risk and 8 individuals (19%) showed improvement in both. All individuals in the study who showed improvement in both hypoglycemia and hyperglycemia risk also showed a reduction in variability.
Therapy changes intended to improve an individual's hypoglycemia or hyperglycemia risk often result in the reduction of one risk at the expense of another. It is important to improve glucose variability to reduce both risks or at least maintain one risk while reducing the other.
Abbott Diabetes Care.
血糖变异性是指一天内血糖的波动以及不同日子同一时间血糖的差异。血糖变异性与低血糖和高血糖相关。本文研究这三个重要指标之间的关系，具体展示低血糖和高血糖风险的降低如何依赖于变异性的变化。
为了解血糖变异性在同时降低低血糖和高血糖风险中的重要性，我们引入血糖风险图——估计糖化血红蛋白百分比（eA1c）与低于70mg/dl的分钟数（MB70），并绘制恒定变异性等高线，以预测在血糖变异性无变化的情况下干预后的风险。
血糖风险图表明，不降低血糖变异性的个体改善了两个指标中的一个（低血糖风险或高血糖风险），但以牺牲另一个为代价。降低变异性对于同时改善两种风险很重要。这些结果在一项针对接受胰岛素治疗的1型和2型糖尿病患者的随机对照试验中收集的数据得到了证实。对于1型糖尿病患者，在为期100天的研究过程中，35名患者中有28名（80%）至少在一种风险（低血糖和/或高血糖）方面有所改善。7名患者（20%）在两种风险方面都有所改善。2型糖尿病患者也观察到类似的数据，43名患者中有36名（84%）至少在一种风险方面有所改善，8名患者（19%）在两种风险方面都有所改善。该研究中所有在低血糖和高血糖风险方面都有所改善的个体，其变异性也有所降低。
旨在改善个体低血糖或高血糖风险的治疗改变通常会导致一种风险降低而以另一种风险为代价。改善血糖变异性以降低两种风险或至少在降低一种风险的同时维持另一种风险很重要。
雅培糖尿病护理公司。
