Diabetes Research and Clinical Practice
Volume 77, Issue 3 , Pages 420-426, September 2007

Chronic hyperglycemia but not glucose variability determines HbA1c levels in well-controlled patients with type 2 diabetes

  • Klaus-Dieter Kohnert

      Affiliations

    • Institute of Diabetes “Gerhardt Katsch”, Greifswalder Str. 11e, D-17495 Karlsburg, Germany
    • Corresponding Author InformationCorresponding author. Tel.: +49 38355 68406; fax: +49 38355 68444.
    • ,
  • Petra Augstein

      Affiliations

    • Institute of Diabetes “Gerhardt Katsch”, Greifswalder Str. 11e, D-17495 Karlsburg, Germany
    • ,
  • Peter Heinke

      Affiliations

    • Institute of Diabetes “Gerhardt Katsch”, Greifswalder Str. 11e, D-17495 Karlsburg, Germany
    • ,
  • Eckhard Zander

      Affiliations

    • Clinics for Diabetes and Metabolic Diseases, Karlsburg, Germany
    • ,
  • Karolina Peterson

      Affiliations

    • Institute of Diabetes “Gerhardt Katsch”, Greifswalder Str. 11e, D-17495 Karlsburg, Germany
    • ,
  • Ernst-Joachim Freyse

      Affiliations

    • Institute of Diabetes “Gerhardt Katsch”, Greifswalder Str. 11e, D-17495 Karlsburg, Germany
    • ,
  • Eckhard Salzsieder

      Affiliations

    • Institute of Diabetes “Gerhardt Katsch”, Greifswalder Str. 11e, D-17495 Karlsburg, Germany

Received 3 August 2006; accepted 24 January 2007. published online 02 March 2007.

Abstract 

To determine the relationships between HbA1c, characteristics of hyperglycemia and glycemic variability in well-controlled type 2 diabetes (HbA1c<7.0%), we studied 63 primary-care patients (36 men and 27 women), aged 34–75 years, with type 2 diabetes for 2–32 years using a continuous glucose monitoring system (CGMS) and standardized meal test (MMT).

Duration of hyperglycemia (>8.0mmol/l), standard deviation score (S.D.-score) and mean amplitude of glycemic excursions (MAGE) were analyzed from CGMS data and postprandial glucose during MMT (PPGMMT).

Patients were hyperglycemic for 5.7h/day (median), experienced 4.1 hyperglycemic episodes/day, and 78% exceeded PPG levels of 8.0mmol/l. HbA1c, though associated with the extent of hyperglycemia (r=0.40, p<0.001), failed to correlate with S.D.-score and MAGE. Multiple regression analysis demonstrated that HbA1c was predicted only by fasting glucose (R2=0.24, p<0.001) but neither by PPGMMT, duration of hyperglycemia, S.D.-score nor MAGE.

CGMS and meal test provide the tools for complete characterization of glycemia in type 2 diabetes.

In well-controlled type 2 diabetes, HbA1c correlates with chronic hyperglycemia but not with glucose variability. Our data suggest that chronic sustained hyperglycemia and glucose fluctuations are two independent components of dysglycemia in diabetes.

Keywords: Extent of hyperglycemia, Glycemic instability, Postprandial glucose response, HbA1c, Continuous glucose monitoring

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PII: S0168-8227(07)00059-9

doi:10.1016/j.diabres.2007.01.021

Diabetes Research and Clinical Practice
Volume 77, Issue 3 , Pages 420-426, September 2007

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