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Glycemic variability and iatrogenic hypoglycemia: how to resolve
Louis Monnier1, Claude Colette1, Eric Renard2
1Medical School of Montpellier, University of Montpellier, Avenue du doyen Giraud, 34093 Montpellier cedex 5, France.
Reducing within-day glucose variability is key to preventing hypoglycemia in type 1 diabetes. Lowering the coefficient of variation for glucose (%CV glucose) below 27% minimizes risk, while below 19% can eliminate it.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Diabetes Management
Background:
- Glycemic variability, not just average glucose, is a risk for hypoglycemia in type 1 diabetes.
- Intensive insulin therapies like Sensor Augmented Pump (SAP) and Automated Insulin Delivery (AID) aim to improve glucose control.
Purpose of the Study:
- To determine the glycemic variability threshold for minimizing hypoglycemia risk in type 1 diabetes.
- To evaluate targets for Sensor Augmented Pump (SAP) and Automated Insulin Delivery (AID) systems.
Main Methods:
- Meta-analysis of 38 randomized controlled trials.
- Analysis of the relationship between glucose coefficient of variation (%CV glucose) and time below 70 mg/dL (TBR < 70 mg/dL).
Main Results:
- A 2.0% reduction in %CV glucose correlated with a 0.50% decrease in TBR < 70 mg/dL.
- Hypoglycemia risk is negligible below 27% %CV glucose and eliminated below 19% %CV glucose.
Conclusions:
- Achieving near-normal glycemic variability is crucial for preventing hypoglycemia in type 1 diabetes.
- Further advancements in insulin delivery systems are needed to reach these targets.
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