Proposed Practical Guidelines to Improve Glycaemic Management by Reducing Glycaemic Variability in People with Type 1 Diabetes Mellitus.

INTRODUCTION

For decades, glycaemic variability (GV) was ignored in clinical practice because its precise assessment was challenging and there were no specific recommendations to reduce it. However, the current widespread use of continuous glucose monitoring (CGM) systems has changed this situation. Associations between high GV and risk of hypoglycaemia, onset of macro- and microvascular complications and mortality have been described in type 1 diabetes (T1D). It is therefore important to identify the causes of excessive glycaemic excursions and make recommendations for people with T1D to achieve better glycaemic management by minimising GV in both the short term and the long term.

METHODS

To achieve these aims, a panel comprising four endocrinologists, one diabetes nurse educator and one nutritionist worked together to reach a consensus on the detection of triggers of GV and propose clinical guidelines to reduce GV and improve glycaemic management by reducing the risk of hypoglycaemias.

RESULTS AND CONCLUSIONS

In total, four different areas of interest were identified, in which the insufficient education and/or training of people with T1D could lead to higher GV: physical activity; dietary habits; insulin therapy, especially when pump-based systems are not used; and other causes of GV increase. Practical, easy-to-follow recommendations to reduce GV in daily activities were then issued, with the aim of enabling people with T1D to reduce either hypoglycaemia or hyperglycaemia episodes. By doing this, their quality of life may be improved, and progression of chronic complications may be prevented or delayed.