title: Near normal HbA1c with stable glucose homeostasis: the ultimate target/aim of diabetes therapy.
abstract: Achieving near normal glucose homeostasis implies that all components of dysglycemia that are present in diabetes states be eliminated. Reducing ambient/overall hyperglycemia is a pre-requisite to eliminate the risk of development and progression of diabetes complications. More controversially however, are the relative and related contributions of postprandial glucose excursions, glucose variability, hypoglycemia and the dawn phenomenon across the spectrum of dysglycemia. For instance, it is likely that the dawn phenomenon contributes to ambient hyperglycemia and that postprandial glucose excursions are at the cross road of ambient hyperglycemia and glucose variability with glucose fluctuations as causative risk factors for hypoglycemia. Proof-of-concept trials such as the ongoing FLAT-SUGAR study are necessary for gaining further insight into the possible harmful effects of some of these features such as excessive glycemic variability and glucose excursions, still considered to be of minor relevance by several diabetologists. Whether their role will be more thoroughly proven through further intervention trials with "hard" endpoints, remains to be seen. In the meantime more consideration should be given to medications aimed at concomitantly reducing ambient/overall hyperglycemia and those additional abnormal glycemic features of dysglycemia.
authors.affiliation: Institute of Clinical Research, University of Montpellier, 641 Avenue Doyen Giraud, 34093 Cedex 5, Montpellier, France. louis.monnier@inserm.fr.
authors.forename: L
authors.initials: L
authors.lastname: Monnier
authors.affiliation: Institute of Clinical Research, University of Montpellier, 641 Avenue Doyen Giraud, 34093 Cedex 5, Montpellier, France.
authors.forename: C
authors.initials: C
authors.lastname: Colette
authors.affiliation: Department of Endocrinology, Hospital Pitié Salpétrière, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Dejager
authors.affiliation: Diabetes Research Group, Swansea University, Swansea, UK.
authors.forename: D R
authors.initials: DR
authors.lastname: Owens
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000378:metabolism* / Q000628:therapy; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006706:Homeostasis / Q000502:physiology*; D006801:Humans
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Glucose homeostasis; Quality of diabetes therapy