Glycemic Gap as a Useful Surrogate Marker for Glucose Variability and Progression of Diabetic Retinopathy

(1) Background: Recent studies have reported that the glucose variability (GV), irrespective of glycosylated hemoglobin (HbA1c), could be an additional risk factor for the development of diabetic retinopathy (DR). However, measurements for GV, such as continuous glucose monitoring (CGM) and fasting plasma glucose (FPG) variability, are expensive and time consuming. (2) Methods: This present study aims to explore the correlation between the glycemic gap as a measurement of GV, and DR. In total, 2565 patients were included in this study. We evaluated the effect of the different types of glycemic gaps on DR progression. (3) Results: We found that the area under the curve (AUC) values of both the glycemic gap and negative glycemic gap showed an association with DR progression. (4) Conclusions: On eliminating the possible influences of chronic blood glucose controls, the results show that GV has deleterious effects that are associated with the progression of DR. The glycemic gap is a simple measurement of GV, and the predictive value of the negative glycemic gap in DR progression shows that GV and treatment-related hypoglycemia may cause the development of DR. Individual treatment goals with a reasonable HbA1c and minimal glucose fluctuations may help in preventing DR.

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Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis

Journal of Clinical Medicine ◽

10.3390/jcm10184116 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4116

Author(s):

Maria Divani ◽

Panagiotis I. Georgianos ◽

Triantafyllos Didangelos ◽

Vassilios Liakopoulos ◽

Kali Makedou ◽

...

Keyword(s):

Continuous Glucose Monitoring ◽

Glycated Albumin ◽

Glucose Monitoring ◽

Area Under The Curve ◽

Glucose Variability ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Diabetic Patients ◽

Lower Efficiency ◽

Target Glucose

Continuous glucose monitoring (CGM) facilitates the assessment of short-term glucose variability and identification of acute excursions of hyper- and hypo-glycemia. Among 37 diabetic hemodialysis patients who underwent 7-day CGM with the iPRO2 device (Medtronic Diabetes, Northridge, CA, USA), we explored the accuracy of glycated albumin (GA) and hemoglobin A1c (HbA1c) in assessing glycemic control, using CGM-derived metrics as the reference standard. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) in diagnosing a time in the target glucose range of 70–180 mg/dL (TIR70–180) in <50% of readings was higher for GA (AUC: 0.878; 95% confidence interval (CI): 0.728–0.962) as compared to HbA1c (AUC: 0.682; 95% CI: 0.508–0.825) (p < 0.01). The accuracy of GA (AUC: 0.939; 95% CI: 0.808–0.991) in detecting a time above the target glucose range > 250 mg/dL (TAR>250) in >10% of readings did not differ from that of HbA1c (AUC: 0.854; 95% CI: 0.699–0.948) (p = 0.16). GA (AUC: 0.712; 95% CI: 0.539–0.848) and HbA1c (AUC: 0.740; 95% CI: 0.570–0.870) had a similarly lower efficiency in detecting a time below target glucose range < 70 mg/dL (TBR<70) in >1% of readings (p = 0.71). Although the mean glucose levels were similar, the coefficient of variation of glucose recordings (39.2 ± 17.3% vs. 32.0 ± 7.8%, p < 0.001) and TBR<70 (median (range): 5.6% (0, 25.8) vs. 2.8% (0, 17.9)) were higher during the dialysis-on than during the dialysis-off day. In conclusion, the present study shows that among diabetic hemodialysis patients, GA had higher accuracy than HbA1c in detecting a 7-day CGM-derived TIR70–180 < 50%. However, both biomarkers provided an imprecise reflection of acute excursions of hypoglycemia and inter-day glucose variability.

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Anticardiolipin antibodies in proliferative diabetic retinopathy: An additional risk factor

Saudi Journal of Ophthalmology ◽

10.1016/j.sjopt.2009.06.001 ◽

2009 ◽

Vol 23 (2) ◽

pp. 165-169 ◽

Cited By ~ 1

Author(s):

Maha Shahin ◽

Amany M. El-Diasty ◽

Mohamed Mabed

Keyword(s):

Diabetic Retinopathy ◽

Risk Factor ◽

Proliferative Diabetic Retinopathy ◽

Anticardiolipin Antibodies ◽

Additional Risk Factor ◽

Additional Risk

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Association between glucose variability as assessed by continuous glucose monitoring (CGM) and diabetic retinopathy in type 1 and type 2 diabetes

Acta Diabetologica ◽

10.1007/s00592-013-0459-9 ◽

2013 ◽

Vol 50 (3) ◽

pp. 437-442 ◽

Cited By ~ 61

Author(s):

Giovanni Sartore ◽

Nino Cristiano Chilelli ◽

Silvia Burlina ◽

Annunziata Lapolla

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Glucose Variability

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Associations between continuous glucose monitoring-derived metrics and diabetic retinopathy and albuminuria in patients with type 2 diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001923 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001923

Author(s):

Satomi Wakasugi ◽

Tomoya Mita ◽

Naoto Katakami ◽

Yosuke Okada ◽

Hidenori Yoshii ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Continuous Glucose Monitoring ◽

Microvascular Complications ◽

Glucose Monitoring ◽

Glucose Variability ◽

Proportional Odds Models ◽

Diabetic Microvascular Complications ◽

Hba1c Levels

IntroductionPreventing the development and progression of diabetic microvascular complications through optimal blood glucose control remains an important challenge. Whether metrics based on continuous glucose monitoring are useful for the management of diabetic microvascular complications is not entirely clear.Research design and methodsThis is an exploratory analysis of an ongoing prospective, multicenter, 5-year follow-up observational study. Study participants included 999 outpatients with type 2 diabetes who underwent continuous glucose monitoring at baseline. Associations between continuous glucose monitoring-derived metrics and the severity of diabetic retinopathy or albuminuria were investigated using multivariable proportional odds models.ResultsThe overall prevalence of diabetic retinopathy was 22.2%. Multivariate analysis with proportional odds models demonstrated that continuous glucose monitoring-derived metrics related to intraday and interday glucose variability are significantly associated with the severity of diabetic retinopathy, even after adjusting for various possible risk factors. However, significant relationships were not observed after adjusting for hemoglobin A1c (HbA1c) levels. The prevalence of microalbuminuria and macroalbuminuria was 20.3% and 6.7%, respectively. Similarly, multivariate analysis demonstrated that those metrics are significantly associated with the severity of albuminuria. These relationships remained significant even after further adjusting for HbA1c levels.ConclusionsContinuous glucose monitoring-derived metrics related to intraday and interday glucose variability are significantly associated with the severity of diabetic retinopathy or albuminuria in patients with type 2 diabetes. Thus, evaluating these metrics might possibly be useful for risk assessment of diabetic microvascular complications.Trial registration number UMIN000032325.

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Oscillatory pattern of glycemic control in patients with diabetes mellitus

Scientific Reports ◽

10.1038/s41598-021-84822-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Manuel Vasquez-Muñoz ◽

Alexis Arce-Alvarez ◽

Magdalena von Igel ◽

Carlos Veliz ◽

Gonzalo Ruiz-Esquide ◽

...

Keyword(s):

Glycosylated Hemoglobin ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Glucose Variability ◽

Specific Pattern ◽

Oscillatory Pattern ◽

Patients With Diabetes ◽

Severity Of The Disease ◽

Pharmacologic Treatments ◽

And Control

AbstractDaily glucose variability is higher in diabetic mellitus (DM) patients which has been related to the severity of the disease. However, it is unclear whether glycemic variability displays a specific pattern oscillation or if it is completely random. Thus, to determine glycemic variability pattern, we measured and analyzed continuous glucose monitoring (CGM) data, in control subjects and patients with DM type-1 (T1D). CGM data was assessed for 6 days (day: 08:00–20:00-h; and night: 20:00–08:00-h). Participants (n = 172; age = 18–80 years) were assigned to T1D (n = 144, females = 65) and Control (i.e., healthy; n = 28, females = 22) groups. Anthropometry, pharmacologic treatments, glycosylated hemoglobin (HbA1c) and years of evolution were determined. T1D females displayed a higher glycemia at 10:00–14:00-h vs. T1D males and Control females. DM patients displays mainly stationary oscillations (deterministic), with circadian rhythm characteristics. The glycemia oscillated between 2 and 6 days. The predictive model of glycemia showed that it is possible to predict hyper and hypoglycemia (R2 = 0.94 and 0.98, respectively) in DM patients independent of their etiology. Our data showed that glycemic variability had a specific oscillation pattern with circadian characteristics, with episodes of hypoglycemia and hyperglycemia at day phases, which could help therapeutic action for this population.

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Lupus anticoagulant positivity in insulin dependent diabetic patients: an additional risk factor in the pathogenesis of diabetic retinopathy?

British Journal of Ophthalmology ◽

10.1136/bjo.84.5.531 ◽

2000 ◽

Vol 84 (5) ◽

pp. 531-533 ◽

Cited By ~ 3

Author(s):

C. Giusti

Keyword(s):

Diabetic Retinopathy ◽

Risk Factor ◽

Lupus Anticoagulant ◽

Diabetic Patients ◽

Additional Risk Factor ◽

Additional Risk ◽

Insulin Dependent ◽

Insulin Dependent Diabetic

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Associations Between Continuous Glucose Monitoring-derived Metrics and Diabetic Retinopathy and Albuminuria in Patients With Type 2 Diabetes

10.21203/rs.3.rs-72340/v1 ◽

2020 ◽

Author(s):

Satomi Wakasugi ◽

Tomoya Mita ◽

Naoto Katakami ◽

Yosuke Okada ◽

Hidenori Yoshii ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Continuous Glucose Monitoring ◽

Microvascular Complications ◽

Glucose Monitoring ◽

Glucose Variability ◽

Proportional Odds Models ◽

Diabetic Microvascular Complications ◽

Hba1c Levels

Abstract BackgroundPreventing the development and progression of diabetic microvascular complications through optimal blood glucose control remains an important challenge. Whether metrics based on continuous glucose monitoring are useful for the management of diabetic microvascular complications is not entirely clear.MethodsThis is an exploratory analysis of an ongoing prospective, multicenter, 5-year follow-up observational study. Study participants included 999 outpatients with type 2 diabetes who underwent continuous glucose monitoring at baseline. Associations between continuous glucose monitoring-derived metrics and the severity of diabetic retinopathy or albuminuria were investigated using multivariable proportional odds models.ResultsThe overall prevalence of diabetic retinopathy was 22.2%. Multivariate analysis with proportional odds models demonstrated that continuous glucose monitoring-derived metrics related to intra-day and inter-day glucose variability are significantly associated with the severity of diabetic retinopathy, even after adjusting for various possible risk factors. However, significant relationships were not observed after adjusting for HbA1c levels. The prevalence of microalbuminuria and macroalbuminuria were 20.3% and 6.7%, respectively. Similarly, multivariate analysis demonstrated that those metrics are significantly associated with the severity of albuminuria. These relationships remained significant even after further adjusting for HbA1c levels. ConclusionsContinuous glucose monitoring-derived metrics related to intra-day and inter-day glucose variability are significantly associated with the severity of diabetic retinopathy or albuminuria in patients with type 2 diabetes. Thus, evaluating these metrics might possibly be useful for risk assessment of diabetic microvascular complications.

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