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Glycemic Variability in Type 1 DiabetesDoes It Matter

One of the first observations that led to the consideration of glycemic variability (GV) as a potential contributor to diabetes complications in type 1 diabetes was from retrospective analysis of data from the Diabetes Control and Complications Trial (DCCT) study, which suggested that risk for retinopathy is determined by factors other than glycosylated hemoglobin (HbA1C). 1,2 In addition to elevated HbA1C levels, fasting glucose levels, post-prandial (PP) hyperglycemia, total glucose exposure, and HbA1C variability over time do correlate strongly with risk for complications in type 1 diabetes. Glycemic variability is defined as the fluctuation, or swings, of blood glucose levels between highs and lows. Of concern are abnormal excursions of blood glucose levels outside of the normal range seen in persons without diabetes. Excessive GV has been shown to be associated but not proven with increased mortality in critically ill patients with type 2 diabetes, as well as increased risk for both microvascular and macrovascular complications. However, the evidence that excessive GV (although the greater in type 1 diabetes) contributes to complications in type 1 diabetes is less convincing.