Glycemic Variability: Risk Factors, Assessment, and Control.

Area of Science:

• Endocrinology
• Metabolic Science
• Diabetes Technology

Background:

• Glycemic variability (GV) signifies metabolic instability and is linked to hypoglycemia and diabetes complications.
• Current diabetes management often focuses on HbA1c, but GV presents a critical, yet often overlooked, aspect of metabolic control.

Purpose of the Study:

• To review the assessment, quantification, and control of glycemic variability in diabetes.
• To highlight the importance of reducing GV for achieving optimal diabetes outcomes.
• To discuss advancements in diabetes technology and pharmacology for GV management.

Main Methods:

• Review of current literature on glycemic variability.
• Discussion of continuous glucose monitoring (CGM) for GV assessment and visualization.
• Analysis of pharmacological agents (GLP-1 receptor agonists, DPP-4 inhibitors) and artificial pancreas systems for GV control.

Main Results:

• Optimal diabetes control requires simultaneous reduction of HbA1c and GV.
• CGM enables precise quantification of GV by tracking amplitude and time dimensions.
• Pharmacological agents and automated insulin delivery systems demonstrate significant GV-reducing effects, particularly in type 2 and type 1 diabetes, respectively.

Conclusions:

• Continuous glucose monitoring (CGM) is essential for tracking and quantifying glycemic variability.
• The next frontier in diabetes care involves actively controlling glucose fluctuations.
• Artificial pancreas systems, utilizing GV data, aim to minimize GV for optimized glycemic control.