Glycemic Gap as a Useful Surrogate Marker for Glucose Variability and Progression of Diabetic Retinopathy.

Shi-Chue Hsing,Chin Lin,Yi-Hao Chen,Wen-Hui Fang,Jiann-Torng Chen

doi:10.3390/jpm11080799

Shi-Chue Hsing, Chin Lin + Show 3 more

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https://doi.org/10.3390/jpm11080799

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Abstract

(1) Background: Recent studies have reported that the glucose variability (GV), irrespective of glycosylated hemoglobin (HbA1c), could be an additional risk factor for the development of diabetic retinopathy (DR). However, measurements for GV, such as continuous glucose monitoring (CGM) and fasting plasma glucose (FPG) variability, are expensive and time consuming. (2) Methods: This present study aims to explore the correlation between the glycemic gap as a measurement of GV, and DR. In total, 2565 patients were included in this study. We evaluated the effect of the different types of glycemic gaps on DR progression. (3) Results: We found that the area under the curve (AUC) values of both the glycemic gap and negative glycemic gap showed an association with DR progression. (4) Conclusions: On eliminating the possible influences of chronic blood glucose controls, the results show that GV has deleterious effects that are associated with the progression of DR. The glycemic gap is a simple measurement of GV, and the predictive value of the negative glycemic gap in DR progression shows that GV and treatment-related hypoglycemia may cause the development of DR. Individual treatment goals with a reasonable HbA1c and minimal glucose fluctuations may help in preventing DR.

Highlights

1046 patients were classified as no diabetic retinopathy (DR), 480 patients as mild NPDR, 757 patients as moderate
Compared with HbA1c variation, self-monitoring of blood glucose, or continuous glucose monitoring (CGM), the glycemic gap is a simple and reliable measurement for glucose variability (GV) in our study, and it can be performed by drawing blood only once. We found that both the glycemic gap and negative glycemic gap have area under the curve (AUC) values that can significantly predict the progression of DR after adjustments; this was not true with the positive glycemic gap (Figure 2)
We have found that a glycemic gap greater than the cutoff level of 45 mg/dL was associated with DR progression

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The common risk factors for DR include poor glycemic control, disease duration, and systolic hypertension. Glycosylated hemoglobin (HbA1c), which indicates an average glucose level over the previous 2–3 months, is the strongest marker of glycemic control [1,2]. Studies have found a U-shaped association between the HbA1c and mortality in patients, and tight glucose control did not improve healthcare outcomes [3,4]. These findings have suggested that aside from

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