Glycemic Variability, High Glucose Increase Mortality Risk in Patients with Type 2 Diabetes

Results from a new study highlighted the importance of achieving normal, stable glucose levels for individuals with type 2 diabetes (T2D). According to the data, drastic glycemic variability and a high level of glucose can magnify an individual’s risk of premature mortality.

Type 2 diabetes is one of the primary causes of premature mortality, and with obesity and energy-dense diets on the rise, there’s been an unprecedented increase in cases of type 2 diabetes. Investigators noted the global prevalence of this condition was estimated to 6.28%, or 462 million individuals in 2017, with a projected growth of 7079 individuals per 100,000 by 2030.

Because diabetes is characterized by elevated blood glucose levels, diabetes-induced glycemic impairment is understood as an independent risk factor for cardiovascular disease and mortality. In this research, it was hypothesized that the incidence of all-cause mortality would be increased among individuals with a higher fasting blood glucose (FBG) variability combined with greater mean fasting blood glucose level (M-FBG).

Analyzing Fasting Blood Glucose Levels

Yahang Liu, Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, and investigators, performed a prospective cohort study to assess the independent and combined impacts of visit-to-visit fasting blood glucose variability (VVV-FBG) and mean fasting blood glucose level on all-cause mortality.

A total of 48,843 Chinese patients with type 2 diabetes were included and 4087 deaths were reported during the median follow-up of 6.99 years. Investigators observed a 23% and 38% increased risk of premature deaths among those with values at the 95th percentile of average real variability (ARV), and mean fasting blood glucose level, respectively, compared with patients whose values were at the 5th percentile of average real variability.

Glycemic variability and mean fasting blood glucose demonstrated a significant interaction on both scales used in the analyses. The relationship between high VVV-FBG and high M-FBG yielded the most considerable risk of all-cause mortality, compared to those with low levels.

Additionally, the analyses revealed that the risk of mortality escalated more rapidly in those with type 2 diabetes who had lower M-FBG combined with lower VVV-FBG.

Interpreting Glycemic Variability

Results reported in this study are consistent with prior research that indicated an association of glucose variability with mortality. These findings suggest that average real variability could be utilized as a practical and feasible intervention for early prevention of glucose deterioration, according to investigators.

Focusing on the reduction of glycemic variability is beneficial, not only for patients exhibiting a high level of average glucose levels, but also for those with moderate levels. Additionally, the team reported that glucose variability was associated with increases in inflammatory cytokines and oxidative stress, “both of which were related to the pathogenesis of atherosclerosis.”

“Our findings indicate that FBG measurements during follow-up can provide additional information about the future risk of all-cause death, highlighting the importance of achieving normal and stable glucose levels simultaneously in the management of blood glucose,” investigators concluded. “Future studies may be needed to further develop the appropriate range of blood glucose variability and to investigate whether decreasing long-term glycemic variability and average glucose level could be associated with reduced risk of early death.”

The study, “Separate and combined effect of visit-to-visit glycaemic variability and mean fasting blood glucose level on all-cause mortality in patients with type 2 diabetes: A population-based cohort study“ was published in Diabetes Obesity and Metabolism.