Institute of Clinical Research, University of Montpellier, 641 Avenue du doyen Giraud, 34093 Montpellier Cedex 5, France.
Diabetes Research Group, Institute of Life Science, Swansea University, Wales, UK.
Diabetes Metab. 2021 May;47(3):101225. doi: 10.1016/j.diabet.2021.101225. Epub 2021 Jan 14.
« Variability in glucose homoeostasis » is a better description than « glycaemic variability » as it encompasses two categories of dysglycaemic disorders: i) the short-term daily glucose fluctuations and ii) long-term weekly, monthly or quarterly changes in either HbA1c, fasting or postprandial plasma glucose. Presently, the relationship between the "variability in glucose homoeostasis" and diabetes complications has never been fully clarified because studies are either observational or limited to retrospective analysis of trials not primarily designed to address this issue. Despite the absence of definitive evidence from randomized controlled trials (RCTs), it is most likely that acute and long-term glucose homoeostasis "cycling", akin to weight and blood pressure "cycling" in obese and hypertensive individuals, are additional risk factors for diabetes complications in the presence of sustained ambient hyperglycaemia. As hypoglycaemic events are strongly associated with short- and long-term glucose variability, two relevant messages can be formulated. Firstly, due consideration should be given to avoid within-day glucose fluctuations in excess of 36% (coefficient of variation) at least for minimizing the inconvenience and dangers associated with hypoglycaemia. Secondly, it seems appropriate to consider that variability in glucose homoeostasis is not only associated with cardiovascular events but is also a causative risk factor via hypoglycaemic episodes as intermediary step. Untangling the" Gordian Knot", to provide confirmation about the impact of variability in glucose homoeostasis and diabetes complications remains a daunting prospect.
“血糖稳态变异性”比“血糖变异性”的描述更为准确，因为它包含了两种血糖紊乱疾病类别：i）短期日常血糖波动和 ii）HbA1c、空腹或餐后血浆葡萄糖的长期每周、每月或每季度变化。目前，“血糖稳态变异性”与糖尿病并发症之间的关系尚未完全阐明，因为这些研究要么是观察性的，要么仅限于试验的回顾性分析，而这些试验并非主要设计用于解决这个问题。尽管缺乏来自随机对照试验 (RCT) 的明确证据，但很可能类似于肥胖和高血压人群中的体重和血压“波动”，急性和长期血糖稳态“波动”是持续环境高血糖情况下糖尿病并发症的额外危险因素。由于低血糖事件与短期和长期血糖变异性密切相关，因此可以提出两个相关信息。首先，应充分考虑避免每天血糖波动超过 36%（变异系数），至少要将与低血糖相关的不便和危险降到最低。其次，似乎可以考虑到，血糖稳态变异性不仅与心血管事件有关，而且通过低血糖发作作为中介步骤，也是一个致病的危险因素。要解开“戈尔迪之结”，提供关于血糖稳态变异性和糖尿病并发症影响的确认仍然是一项艰巨的任务。
