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Association of glycemic variability and the anti-glycemic medication effect score in adults with type 2 diabetes

Pennie J Taylor*, Kylie Lange, Campbell H Thompson, Wittert Gary & Grant D Brinkworth

While evidence implicates glycemic variability (GV) as an independent risk factor for type 2 diabetes (T2D) complications, individual characteristics and factors that determine and influence GV remain unclear. This study explored associations between GV and individual characteristics including age, body fat, diabetes duration, physical activity, gender, glycated haemoglobin (HbA1c) with a focus on anti-glycemic medication use. An observational, cross-sectional investigation was conducted as a secondary analysis on baseline data of 95 participants (age: 35-65 y; Body Mass Index (BMI): 26-45 kg/m²) with T2D (HbA1c ≥ 7.0% and/or using diabetes medication) who participated in a Randomised Control Trial. Three glycemic variability indices were calculated using interstitial glucose level readings (mean of 5-mins) over a 48 h period, collected by continuous blood glucose monitoring. Multiple linear regressions were used to examine the association between the participant characteristics of interest and the GV indices. There were significant positive associations between all GV indices and anti-glycemic medication use (all; P<0.004). Similarly, significant positive associations between all GV indices and HbA1c (all; P<0.001) were observed. However, associations between HbA1c and all GV indices plateaued above an HbA1c of 8%. Finally, there were no observable associations between the GV indices and any other characteristics. From a range of patient characteristics, only the characteristic of a greater anti-glycemic medication score was significantly associated with greater GV in overweight or obese individuals with T2D. These data suggest clinical targets for optimal glycemic management may require greater consideration of the impact of pharmacotherapy on GV.