title: Evaluation of glycemic variability in well-controlled type 2 diabetes mellitus.
abstract: OBJECTIVE
  It is necessary to evaluate glucose variability and postprandial hyperglycemia in patients with well-controlled type 2 diabetes mellitus because of the limitations associated with hemoglobin A1c (HbA1c) measurements. We evaluated parameters reflecting postprandial hyperglycemia and glycemic variability in patients with optimal HbA1c.
  
  
  METHODS
  Thirty-nine patients with HbA1c levels below 7% were recruited to the study. A continuous glucose monitoring system (CGMS) was applied for two 72-h periods. 1,5-Anhydroglucitol (1,5-AG) and fructosamine (FA) were measured as parameters for postprandial hyperglycemia and glucose variability. Using CGMS data, the following postprandial hyperglycemia parameters were calculated: mean postprandial maximum glucose (MPMG) and area under the curve for glucose above 180 mg/dL (AUC-180). To measure glycemic variability, we calculated mean amplitude of glucose excursion (MAGE) using a classical (MAGEc) and new method (MAGE group of sign [MAGEgos]).
  
  
  RESULTS
  The baseline HbA1c level was 6.3±0.3%. The mean MPMG was 10.34±1.84 mmol/L, and the mean AUC-180 was 0.17±0.23 mmol/L/day. The mean MAGEgos was 3.27±1.29 mmol/L, and MAGEc was 4.30±1.43 mmol/L, indicating glycemic variability in our patients. The mean levels of 1,5-AG and FA were 16.7±7.4 μg/mL and 273.0±22.5 μmol/L, respectively. In a correlation analysis, FA was significantly correlated with MPMG, AUC-180, MAGEgos, and MAGEc. In contrast, 1,5-AG was only correlated with AUC-180.
  
  
  CONCLUSIONS
  This study demonstrated postprandial hyperglycemia and glycemic variability in subjects with well-controlled diabetes. FA may reflect postprandial hyperglycemia and glycemic variability, but 1,5-AG may be of limited value for assessing glucose variability in patients with well-controlled type 2 diabetes mellitus.
authors.affiliation: Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Suk
authors.initials: S
authors.lastname: Chon
authors.forename: Yun Jung
authors.initials: YJ
authors.lastname: Lee
authors.forename: Gemma
authors.initials: G
authors.lastname: Fraterrigo
authors.forename: Paolo
authors.initials: P
authors.lastname: Pozzilli
authors.forename: Moon Chan
authors.initials: MC
authors.lastname: Choi
authors.forename: Mi-Kwang
authors.initials: MK
authors.lastname: Kwon
authors.forename: Sang Ouk
authors.initials: SO
authors.lastname: Chin
authors.forename: Sang Youl
authors.initials: SY
authors.lastname: Rhee
authors.forename: Seungjoon
authors.initials: S
authors.lastname: Oh
authors.forename: Young-Seol
authors.initials: YS
authors.lastname: Kim
authors.forename: Jeong-Taek
authors.initials: JT
authors.lastname: Woo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D003847:Deoxyglucose / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology; D005260:Female; D019270:Fructosamine / Q000097:blood; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D056910:Republic of Korea / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D003847:Deoxyglucose; D019270:Fructosamine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human; C006584:1,5-anhydroglucitol