Glucose variability: where it is important and how to measure it

J Hans DeVries, J Hans DeVries

Abstract

Glucose variability predicts hypoglycemia in both type 1 and type 2 diabetes and has consistently been related to mortality in nondiabetic patients in the intensive care unit. SD and mean amplitude of glycemic excursions have historically been very popular measures of glucose variability. For reasons outlined in this counterpoint, I propose to use coefficient of variation and the mean absolute glucose change as preferred measures of glucose variability.

Figures

FIG. 1.
FIG. 1.
Visualization of glucose variability. Solid line: a given excursion. Dashed line: higher glucose variability due to a higher frequency of oscillation. Dotted line: higher glucose variability due to a larger amplitude. Note that the mean and area under the curve are identical in the three situations.
FIG. 2.
FIG. 2.
Glucose profiles from the prandial (triangles) and basal (squares) insulin groups in HEART2D. Reproduced with permission from Siegelaar et al. (20).
FIG. 3.
FIG. 3.
Two fictitious patients with identical mean and SD of glucose throughout a 20-h period, but markedly different glucose variability. The MAG change of both patients differs by a factor 19. Reproduced with permission from Hermanides et al. (27).

References

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Source: PubMed

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