Ajjan R A
LIGHT Laboratories, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Diabetes Obes Metab. 2024 Dec;26 Suppl 7(Suppl 7):3-16. doi: 10.1111/dom.16098. Epub 2024 Dec 5.
With the widespread use of continuous glucose monitoring (CGM), glycaemic variability (GV) is a glucose metric that has been gaining increasing attention. However, unlike other glucose metrics that are easily defined and have clear targets, GV has a large number of different measures given the complexity involved in assessment. While variabilities in HbA1c, fasting and postprandial glucose have been incorporated under the GV banner, short-term variability in glucose, within day and between days, is more in keeping with the correct definition of GV. This review is focused on short-term GV, as assessed by CGM data, although studies calculating GV from capillary glucose testing are also mentioned as appropriate. The different measures of GV are addressed, and their potential role in microvascular and macrovascular complications, as well as patient-related outcomes, discussed. It should be noted that the independent role of GV in vascular pathology is not always clear, given the inconsistent findings in different populations and the close association between GV and hypoglycaemia, itself an established risk factor for adverse outcomes. Therefore, this review attempts, where possible, to disentangle the contribution of GV to diabetes complications from other glycaemic parameters, particularly hypoglycaemia. Evidence to date strongly suggests an independent role for GV in vascular pathology but future large-scale outcome studies are required to fully understand the exact contribution of this metric to vascular complications. This can be followed by setting appropriate GV measures and targets in different diabetes subgroups, in order to optimise glycaemic management and limit the risk of complications.
随着持续葡萄糖监测(CGM)的广泛应用,血糖变异性(GV)作为一种血糖指标越来越受到关注。然而,与其他易于定义且有明确目标的血糖指标不同,鉴于评估过程的复杂性,GV有大量不同的测量方法。虽然糖化血红蛋白(HbA1c)、空腹血糖和餐后血糖的变异性已被纳入GV范畴,但日内和日间血糖的短期变异性更符合GV的正确定义。本综述重点关注通过CGM数据评估的短期GV,不过也会酌情提及从毛细血管血糖检测计算GV的研究。文中讨论了GV的不同测量方法及其在微血管和大血管并发症以及患者相关结局中的潜在作用。应当指出的是,鉴于不同人群的研究结果不一致,以及GV与低血糖之间的密切关联(低血糖本身就是不良结局的既定危险因素),GV在血管病变中的独立作用并不总是明确的。因此,本综述尽可能尝试将GV对糖尿病并发症的影响与其他血糖参数,特别是低血糖区分开来。迄今为止的证据有力地表明GV在血管病变中具有独立作用,但需要未来的大规模结局研究来充分了解该指标对血管并发症的确切影响。在此之后,可以在不同糖尿病亚组中设定适当的GV测量方法和目标,以优化血糖管理并降低并发症风险。