title: Glycemic variability and diabetes retinopathy: a missing link.
abstract: Daily glucose variability, such as fasting plasma glucose fluctuation or postprandial hyperglycemia, has been proposed as contributors to diabetes-related macrovascular complications. However, its impacts on microvascular complications, such as diabetes retinopathy remain controversial. We reviewed the current evidence of the relationship between glycemic variability and diabetes retinopathy in patients with type 1 or type 2 diabetes. In general, the short-term glycemic fluctuation, either expressed as standard deviation of fasting glucose or mean glucose levels, may contribute to the development or progression of diabetic retinopathy in patients with type 2 diabetes, whereas long-term glycemic fluctuation, reflected by variation of levels of HbA1c, appeared to show a stronger association with diabetes retinopathy both in patients with type 1 and type 2 diabetes. These findings emphasize the need to reduce glycemic variability by various measures in order to reduce development and progression of diabetes retinopathy both in type 1 and type 2 diabetes patients.
authors.affiliation: Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Cherng-Ru
authors.initials: CR
authors.lastname: Hsu
authors.affiliation: Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yu-Tsung
authors.initials: YT
authors.lastname: Chen
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Medical Technology, National Chung Hsing University, Taichung, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan. Electronic address: whhsheu@vghtc.gov.tw.
authors.forename: Wayne H-H
authors.initials: WH
authors.lastname: Sheu
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000209:etiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008954:Models, Biological; D057285:Precision Medicine
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Diabetes retinopathy; Glycemic variability; Macrovascular complications; Microvascular complications; Postprandial hyperglycemia