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Glycemic Variability (GV) Increases Risk For Poorer Outcomes  

Feb 29, 2020
Editor: Steve Freed, R.PH., CDE

Author: Sandra Zaki, PharmD Candidate, Florida A&M University

Maintaining a steady glycemic variability (GV) through lifestyle, proper treatment regimen, and responsible dietary nutrition can help manage a type 2 diabetic condition. 

The acute phase of insulin secretion is the first stage in the process of insulin secretion. This phase is characterized by high levels of insulin concentration in the plasma. The insulin levels rise very fast for about 5 minutes. Previous studies have shown that glycemic variability (GV) can help determine the body’s glycemic regulation quality. A previous study done by researchers of the present study found that early-phase insulin secretion did not impact GV in any way for patients who have been recently diagnosed with T2D. This study seeks to find out the relationship between β-cell function and GV, the term for the differences in blood glucose concentrations throughout a day, in patients with T2D who are receiving insulin treatment. 

The study population consisted of 507 participants (356 men and 151 women) diagnosed with T2D. The selection criteria included an age limit of 18 years and above, the presence of T2D, and evidence of continuing stable insulin treatment regimen of over three months.  The study population filled a questionnaire for general information such as date of birth, alcohol and smoking habits, and family history of diabetes. 

The participants were injected with a solution of 10% Arginine hydrochloride, and blood was drawn after 2, 4, and 6 minutes. The blood samples were analyzed, and the response of C-peptide to arginine was calculated. This was done to determine the functions of the β-cells during acute phase insulin secretion. The participants also underwent monitoring through the use of a CGM system. The CGM sensor was on the second day of admission, and the CV or the index for GV assessment was calculated. The study groups adhered to a specific diet while in hospitalization: daily intake of 25kcal/kg with the calories divided into 55% carbohydrates, 17% proteins, and 28% fats. Blood was drawn the following morning following a 10-12 hour fast overnight, and underwent several biochemical analytical tests. 

Trend analyses were done using the Cochran-Armitage trend test. The association of different parameters of β-cell functions with glycemic control was determined using multiple logistic regression analysis. P<0.05 was considered statistically significant. 

The study found that patients receiving insulin treatment and who also have lower levels of C-protein had a higher GV. This also meant that such patients would benefit more from anti-diabetic medication targeted at reducing blood glucose concentration fluctuations. Such types of medication include alpha-glucosidase inhibitors and Na-Glu transporter two inhibitors.  

The study is robust due to the method of measuring the β-cell function. The CGM system was, however, limited and only assisted in the calculation of GV over a short time (24-48 hours). Further studies are warranted to show a clear relationship between GV and the secretion of insulin over a long time. Acute C-peptide response (ACPR) was found to be the predominant compound by the arginine test and was considered far more significant to other methods of testing for β-cell functioning in GV in patients with T2D undergoing treatment with insulin.  


Practice Pearls: 

  • T2D can get worse in an individual who has high levels of C-Protein (ACPR)
  • β-Cells’ function can be impaired further in T2D due to glycemic variation, leading to worsening diabetic conditions.
  • Low levels of C-protein indicate that anti-diabetic agents used in treatment will be more effective.


Si Y., Shen Y., Lu J., Ma X., Zhang L., Mo Y., Lu W., Zhu W., Bao Y., Hu G., Zhou J. (2020). Impact of acute-phase insulin secretion on GV in insulin-treated patients with T2D. Endocrine. https://doi.org/10.1007/s12020-020-02201-y 



Sandra Zaki, PharmD Candidate, Florida A&M University