INFLUENCE OF GLYCEMIC VARIABILITY ON THE COMPENSATION OF DIABETES MELLITUS
Keywords:diabetes mellitus, variability of glycemia, hypoglycemia
There is a scientific discussion about the completeness of the reflection of compensation of diabetes mellitus (DM) through the HbA1c indices in modern clinical endocrinology today. The negative influence of the glycemic variability (GV) on the development and progression of chronic complications remains undervalued. The GV in patients with DM has been studied by calculating the coefficient of variability (CV) using a continuous glucose monitoring (CGM) device iPRO2. Associative relations between CV, HbA1c and the frequency of hypoglycemic states have been determined. Patients with type 1 DM (n=34) were treated using bolus-basal insulin therapy, patients with type 2 DM (n=18) – using different kinds of hypoglycemic therapy (HGT). The frequency of cardiovascular complications (CVC) in patients with DM was determined.
Patients with DM have a high and moderate degree of GV which are not reflected through the HbA1c indexes, because correlation between CV and HbA1c is not reliable (r=-0.02; p<0.05). A positive direct correlation between the CV and the time of hypoglycemia (r=0.70; p<0.05) confirms the reflection of «unrecognized» and concealed hypoglycemic states through the parameters of GV. 55,7 % of patients with high GV have severe CVC. Significantly lower GV was found in patients with type 1 DM that took insulin analogues, compared with patients, that take biosynthetic insulins (p<0.05). The dependence of GV from HGT in patients with type 2 DM was not detected due to the insufficient amount of data for comparison.
GV parameters, determined using of CGM reflect «unrecognized» and latent hypoglycemic states, that allows to estimate more deeply and objectively the compensation of DM. Low degree of GV can be used as an additional criterion of compensation of DM.
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