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Glucose Variability Affects Hemoglobin A1c

At any given average glucose level, high variability results in higher glycosylated hemoglobin level. In a study involving 427 diabetic patients (63% had type 1 diabetes), investigators obtained about 2700 blood glucose measurements per patient during a 3-month period. Glucose variability affected HbA1c in type 1 diabetic patients. In patients with poor control (average glucose level, 240 mg/dL), low glucose variability (standard deviation, 30 mg/dL) was associated with HbA1c of 8.7%, whereas high variability (standard deviation, 100 mg/dL) was associated with HbA1c of 9.8%. In patients with better glycemic control (average glucose level, 160 mg/dL), variability had less effect on HbA1c (HbA1c, 7.0% in low-variability patients and 7.4% in high-variability patients). The authors speculate that the oxidative stress that accompanies highly variable glucose levels might affect the glycation process. The effect was not significant in type 2 diabetic patients, perhaps because the study included too few type 2 patients with substantial variability. Kuenen JC et al. Does glucose variability influence the relationship between mean plasma glucose and HbA1c levels in type 1 and type 2 diabetic patients? Diabetes Care 2011 Aug; 34:1843. (http://dx.doi.org/10.2337/dc10-2217)