Should minimal blood glucose variability become the gold standard of glycemic control?

Irl B. Hirsch, Michael Brownlee

Research output: Contribution to journalArticle

307 Citations (Scopus)

Abstract

The Diabetes Complications and Control Trial (DCCT) established glycosylated hemoglobin (A1C) as the gold standard of glycemic control, with levels ≤7% deemed appropriate for reducing the risk of vascular complications. Yet, even when A1Cs were comparable between intensively treated subjects and their conventionally treated counterparts, the latter group experienced a markedly higher risk of progression to retinopathy over time. Our speculative explanation, based on the discovery that hyperglycemia-induced oxidative stress is the chief underlying mechanism of glucose-mediated vascular damage, was that glycemic excursions were of greater frequency and magnitude among conventionally treated patients, who received fewer insulin injections. Subsequent studies correlating the magnitude of oxidative stress with fluctuating levels of glycemia support the hypothesis that glucose variability, considered in combination with A1C, may be a more reliable indicator of blood glucose control and the risk for long-term complications than mean A1C alone.

Original languageEnglish (US)
Pages (from-to)178-181
Number of pages4
JournalJournal of Diabetes and its Complications
Volume19
Issue number3
DOIs
StatePublished - May 2005

Fingerprint

Blood Glucose
Blood Vessels
Oxidative Stress
Glucose
Glycosylated Hemoglobin A
Diabetes Complications
Hyperglycemia
Insulin
Injections

Keywords

  • Diabetes complications
  • Glucose variability
  • Oxidative stress
  • Reactive oxygen species

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Should minimal blood glucose variability become the gold standard of glycemic control? / Hirsch, Irl B.; Brownlee, Michael.

In: Journal of Diabetes and its Complications, Vol. 19, No. 3, 05.2005, p. 178-181.

Research output: Contribution to journalArticle

@article{12b2c8ffc26a472b862be8f569d716ff,
title = "Should minimal blood glucose variability become the gold standard of glycemic control?",
abstract = "The Diabetes Complications and Control Trial (DCCT) established glycosylated hemoglobin (A1C) as the gold standard of glycemic control, with levels ≤7{\%} deemed appropriate for reducing the risk of vascular complications. Yet, even when A1Cs were comparable between intensively treated subjects and their conventionally treated counterparts, the latter group experienced a markedly higher risk of progression to retinopathy over time. Our speculative explanation, based on the discovery that hyperglycemia-induced oxidative stress is the chief underlying mechanism of glucose-mediated vascular damage, was that glycemic excursions were of greater frequency and magnitude among conventionally treated patients, who received fewer insulin injections. Subsequent studies correlating the magnitude of oxidative stress with fluctuating levels of glycemia support the hypothesis that glucose variability, considered in combination with A1C, may be a more reliable indicator of blood glucose control and the risk for long-term complications than mean A1C alone.",
keywords = "Diabetes complications, Glucose variability, Oxidative stress, Reactive oxygen species",
author = "Hirsch, {Irl B.} and Michael Brownlee",
year = "2005",
month = "5",
doi = "10.1016/j.jdiacomp.2004.10.001",
language = "English (US)",
volume = "19",
pages = "178--181",
journal = "Journal of Diabetes and its Complications",
issn = "1056-8727",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Should minimal blood glucose variability become the gold standard of glycemic control?

AU - Hirsch, Irl B.

AU - Brownlee, Michael

PY - 2005/5

Y1 - 2005/5

N2 - The Diabetes Complications and Control Trial (DCCT) established glycosylated hemoglobin (A1C) as the gold standard of glycemic control, with levels ≤7% deemed appropriate for reducing the risk of vascular complications. Yet, even when A1Cs were comparable between intensively treated subjects and their conventionally treated counterparts, the latter group experienced a markedly higher risk of progression to retinopathy over time. Our speculative explanation, based on the discovery that hyperglycemia-induced oxidative stress is the chief underlying mechanism of glucose-mediated vascular damage, was that glycemic excursions were of greater frequency and magnitude among conventionally treated patients, who received fewer insulin injections. Subsequent studies correlating the magnitude of oxidative stress with fluctuating levels of glycemia support the hypothesis that glucose variability, considered in combination with A1C, may be a more reliable indicator of blood glucose control and the risk for long-term complications than mean A1C alone.

AB - The Diabetes Complications and Control Trial (DCCT) established glycosylated hemoglobin (A1C) as the gold standard of glycemic control, with levels ≤7% deemed appropriate for reducing the risk of vascular complications. Yet, even when A1Cs were comparable between intensively treated subjects and their conventionally treated counterparts, the latter group experienced a markedly higher risk of progression to retinopathy over time. Our speculative explanation, based on the discovery that hyperglycemia-induced oxidative stress is the chief underlying mechanism of glucose-mediated vascular damage, was that glycemic excursions were of greater frequency and magnitude among conventionally treated patients, who received fewer insulin injections. Subsequent studies correlating the magnitude of oxidative stress with fluctuating levels of glycemia support the hypothesis that glucose variability, considered in combination with A1C, may be a more reliable indicator of blood glucose control and the risk for long-term complications than mean A1C alone.

KW - Diabetes complications

KW - Glucose variability

KW - Oxidative stress

KW - Reactive oxygen species

UR - http://www.scopus.com/inward/record.url?scp=18144415490&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=18144415490&partnerID=8YFLogxK

U2 - 10.1016/j.jdiacomp.2004.10.001

DO - 10.1016/j.jdiacomp.2004.10.001

M3 - Article

VL - 19

SP - 178

EP - 181

JO - Journal of Diabetes and its Complications

JF - Journal of Diabetes and its Complications

SN - 1056-8727

IS - 3

ER -