Acute glucose fluctuations should be considered alongside fasting and postprandial hyperglycemia as key therapeutic targets in type 2 diabetes to reduce oxidative stress and cardiovascular risk.
May support considering glycemic variability in T2D management; hypothesis-generating for outcome trials.
chronic hyperglycemia acute glucose fl uctuations Acute Glucose Fluctuations and Chronic Sustained Hyperglycemia as Risk Factors for Cardiovascular Diseases in Patients with Type 2 Diabetes patients result in an activation of oxidative stress with an overproduction of superoxide by the mitochondrial electron-transfer chain [4] ( Fig. This activation in turn produces a cascade of such deleterious metabolic events as enhanced polyol activity, increased formation of advanced glycation end-products, activation of protein kinase C and nuclear factor B, and increased hexosamine pathway fl ux It is now well established that hyperglycemia both at fasting and during postprandial periods results in exaggerated and accelerated glycation. For instance, all the studies conducted in type 1 and type 2 diabetes have clearly shown a strong positive relationship between HbA1c levels and plasma glucose levels at fasting and over postprandial periods The latter relationship was considered suffi ciently demonstrative to serve as a reference in the recent Standards of Medical Care in Diabetes that are published every year by the American Diabetes Association To day, HbA1c is unanimously recognized as a reliable marker for the overall glucose exposure and its direct consequence, an excessive rate of glycation The simplicity of this concept masks more complex phenomena because HbA1c is an integrator of both fasting
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Colette et al. (2007) studied this question.