Relationship between daily and day-to-day glycemic variability and increased oxidative stress in type 2 diabetes.
OBJECTIVE
To determine the association of daily and day-to-day glucose variability with oxidative stress.


METHODS
This was a cross-sectional analysis of 68 patients with type 2 diabetes mellitus (T2DM) over 72h of continuous glucose monitoring. Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) were measured before breakfast on day 1. Glucose variability, mean glucose level (MGL), mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD) in glucose levels and area under the postprandial plasma glucose curve (AUCPP) were measured on days 2 and 3. Plasma oxidant capacity against N,N-diethylparaphenylenediamine was measured with the diacron-reactive oxygen metabolites (d-ROMs) test on day 1.


RESULTS
Overall, 66.2% males with the mean age of 63.2±12.6years, diabetes duration of 12.9±10.4years, and HbA1c level of 8.1±1.6% (65±17mmol/mol) were included. MGL (r=0.330), HbA1c (r=0.326), MAGE (r=0.565), MODD (r=0.488), and AUCPP(r=0.254) exhibited significant correlations with d-ROMs and not FPG; these correlations remained significant after adjustment for clinical factors (sex, age, duration of diabetes, smoking habit, insulin use, statin use, angiotensin II receptor blocker use, BMI, LDL-C, HDL-C, TG, eGFR, and systolic blood pressure) (R2=0.268, R2=0.268, R2=0.417, R2=0.314, and R2=0.347, respectively). MAGE was significantly correlated with MODD (r=0.708) and MAGE and MODD were independently correlated with d-ROMs by multivariate analysis.


CONCLUSIONS
Therefore, oxidative stress is associated with daily and day-to-day glucose variability in patients with T2DM.
Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Japan. Electronic address: s6018@nms.ac.jp.
Makoto
M
Ohara
Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Japan.
Tomoyasu
T
Fukui
Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Japan.
Motoshi
M
Ouchi
Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (DNHMED), Yamagata University Faculty of Medicine, Japan.
Kentaro
K
Watanabe
Division of Geriatric Medicine, Nippon Medical School, Japan.
Tatsuya
T
Suzuki
Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Japan.
Saki
S
Yamamoto
Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Japan.
Takeshi
T
Yamamoto
Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Japan.
Toshiyuki
T
Hayashi
Department of Internal Medicine, Oarai Coast Core Clinic, Japan.
Kenzo
K
Oba
Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Japan.
Tsutomu
T
Hirano
D000368:Aged; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D038321:Glycemic Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology*; D017382:Reactive Oxygen Species / Q000378:metabolism*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D017382:Reactive Oxygen Species; C517652:hemoglobin A1c protein, human
Diacron-reactive oxygen metabolites; Glucose monitoring; Glucose variability; Oxidative stress; Type 2 diabetes mellitus