BACKGROUND: Type 1 diabetes is associated with more severe glycemic variability and more frequent hypoglycemia than type 2 diabetes. Glycemic variability is associated with poor glycemic control and diabetic complications. In this study, we demonstrate the clinical usefulness of serum 1,5-anhydroglucitol (1,5-AG) for assessing changes in glycemic excursion in type 1 diabetes. METHODS: Seventeen patients with type 1 diabetes were enrolled in this study. A continuous glucose monitoring system (CGMS) was applied twice at a 2-week interval to evaluate changes in glycemic variability. The changes in serum glycemic assays, including 1,5-AG, glycated albumin and hemoglobin A1c (HbA1c), were also evaluated. RESULTS: Most subjects showed severe glycemic excursions, including hypoglycemia and hyperglycemia. The change in 1,5-AG level was significantly correlated with changes in the glycemic excursion indices of the standard deviation (SD), mean amplitude of glucose excursion (MAGE), lability index, mean postmeal maximum glucose, and area under the curve for glucose above 180 mg/dL (r=-0.576, -0.613, -0.600, -0.630, and -0.500, respectively; all P<0.05). Changes in glycated albumin were correlated with changes in SD and MAGE (r=0.495 and 0.517, respectively; all P<0.05). However, changes in HbA1c were not correlated with any changes in the CGMS variables. CONCLUSION: 1,5-AG may be a useful marker for the assessment of short-term changes in glycemic variability. Furthermore, 1,5-AG may have clinical implications for the evaluation and treatment of glycemic excursions in type 1 diabetes.
Diabetes Complications ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia

Global diabetes prevalence is increasing every year. Glucose control is the most important aspect of diabetes management, and numerous studies on diabetes treatment have shown the importance of glucose reduction in the prevention of diabetic complications. Glucose control may be influenced by three components of glycemia (a "triad"): fasting hyperglycemia, postprandial hyperglycemia, and HbA1c. Which of these components most influences glucose control is still under debate. However, there are sufficient data to demonstrate the importance of postprandial glucose control in the prevention of cardiovascular complications. A few pivotal studies have been performed on the association of fasting or postprandial hyperglycemia with overall glucose control. These studies suggest that different components of glycemia have variable effects according to degree of glucose control. Also, glycemic variability is emphasized as a new component in glucose control. More studies should be performed to find better ways of controlling postprandial hyperglycemia for the prevention of cardiovascular complications of diabetes.
Diabetes Complications ; Fasting ; Glucose ; Hyperglycemia ; Prevalence

Poorly controlled diabetes is associated with development of various diabetic complications. Large controlled clinical trials have demonstrated that intensive glycemic control can significantly decrease the development and/or progression of microvascular complications of diabetes. Until recently, the goal of treatment in diabetic subjects has been reducing HbA1c level, with a strong emphasis on fasting plasma glucose. Although control of fasting hyperglycemia is necessary, that alone is not sufficient to obtain optimal glycemic control. Recently, a growing body of evidence has suggested that postprandial hyperglycemia has greater impact on diabetes complications than does average blood glucose as measured by HbA1c or fasting plasma glucose. This report briefly reviews the measurement and treatment goal of postprandial glucose.
Blood Glucose ; Diabetes Complications ; Diabetes Mellitus ; Fasting ; Glucose ; Hyperglycemia ; Plasma

Introduction: Chronic and post-prandial hyperglycemia are independent risk factors for diabetic complications. Glycemic patterns among hemodialysis end-stage-renal-disease (ESRD) differ as glucose metabolism changes with declining kidney function with more pronounced glycemic fluctuations. The objectives of this study are to determine glycemic patterns on hemodialysis days, the magnitude of post-hemodialysis rebound hyperglycemia (PHH) and their associated factors. Methodology: 148 patients on hemodialysis were analysed, 91 patients had end-stage-diabetic-renal disease (DM-ESRD), and 57 patients had end-stage-non-diabetic renal disease (NDM-ESRD). Glycemic patterns and PHH data were obtained from 11-point and 7-point self-monitoring blood glucose (SMBG) profiles on hemodialysis and non-hemodialysis days. PHH and its associated factors were analysed with logistic regression. Results: Mean blood glucose on hemodialysis days was 9.33 [SD 2.7] mmol/L in DM-ESRD patients compared to 6.07 [SD 0.85] mmol/L in those with NDM-ESRD (p<0.001). PHH occurred in 70% of patients and was more pronounced in DM-ESRD compared to NDM-ESRD patients (72.5% vs 27.5%; OR 4.5). Asymptomatic hypoglycemia was observed in 18% of patients. DM-ESRD, older age, previous IHD, obesity, high HbA1c, elevated highly-sensitive CRP and low albumin were associated with PHH. Conclusion DM-ESRD patients experienced significant PHH in our cohort. Other associated factors include older age, previous IHD, obesity, high HbA1c, elevated hs-CRP and low albumin.
Renal Dialysis ; Diabetes Complications ; Hyperglycemia ; Risk Factors ; Asian

Diabetic neuropathy is a common diabetic complication.The application of metabolomics in the research on diabetic neuropathy is beneficial for us to understand the pathophysiological processes and overall metabolic disturbance of the nervous system under the condition of hyperglycemia,decipher the pathogenesis of diabetic neuropathy,and mine the potential biomarkers for clinical diagnosis and treatment.Long-term hyperglycemia may lead to disorders in multiple pathways,such as tricarboxylic acid circle,amino acid metabolism,and lipid metabolism.These metabolic changes are closely associated with the injuries of the peripheral and central nervous system.In the paper,we reviewed the metabolomics-based studies about diabetic neuropathy in the last five years.
Biomarkers ; Diabetes Mellitus ; Diabetic Neuropathies ; Humans ; Hyperglycemia/complications* ; Metabolomics

Type 2 diabetes mellitus is a progressive process. With the course of the disease progress, microvascular and macrovascular complications always happen. Thrombotic events caused by macrovascular complications, including coronary heart diseases and cerebrovascular diseases, are the main fatal factor for the patients with type 2 diabetes. Endothelial dysfunction, coagulative activation, impaired fibrinolysis, together with hyper-reactive platelets contribute to the diabetic prothrombotic state, which is strongly related to the macrovascular complications. In particular, the hyper-reactive platelets play a fundamental role among them. Type 2 diabetes is characterized by several metabolic dysfunctions such as hyperglycemia, insulin resistance and shortage, oxidative stress, systemic inflammation, obesity, and dyslipidemia. These metabolic dysfunctions work together to promote the formation of hyper-reactive platelets, which are distinctive in type 2 diabetes. The regular antiplatelet drugs, like aspirin, show limited inhibitory effect on them. Hence, studying the mechanism behind the hyper-reactive platelets could provide a brand-new view on the prevention of macrovascular complications and cardiovascular events in type 2 diabetes.
Blood Platelets ; Diabetes Mellitus, Type 2/drug therapy* ; Humans ; Hyperglycemia/complications* ; Insulin Resistance ; Obesity/complications*

Care of the elderly population with diabetes may not be restricted to the management of hyperglycemia, associated risk factors, and specific diabetic complications. An integrated approach should also include the assessment and management of gerontological problems. Both diabetes mellitus and aging interact toward the direction of the increased incidence of geriatric syndromes. Education is a common element of both diabetes control and geriatric syndrome care. However, it has been perceived that conventional education programs for diabetics are not as effective for the elderly. We have designed geriatric reinforced education (GRE) for application in older diabetics with geriatric syndromes. We observed that the application of GRE improved the glucose control and the status of geriatric syndromes in older adults with diabetes. In summary, in terms of integrating the care of coexisting diabetes and geriatric problems, GRE may be a beneficial tool for the management of older adults with diabetes.
Adult ; Aged ; Aging ; Diabetes Complications ; Diabetes Mellitus* ; Education ; Geriatric Assessment ; Glucose ; Humans ; Hyperglycemia ; Incidence ; Risk Factors

Diabetes is characterized by hyperglycemia, and chronic hyperglycemia leads to microvascular and macrovascular complications. Glycemic control is assessed and monitored by hemoglobin A1c and self-monitoring of blood glucose. Most guidelines recommend achieving hemoglobin A1c targets of <6.5% or 7%. Improved glycemic control reduces microvascular complications. However, intensive glycemic-control can have different effects on cardiovascular complications depending on the patient population. The glycemic targets should be individualized based on each patient's characteristics, such as age, duration of diabetes, accompanying comorbidities, risk of severe hypoglycemia, life expectancy, and attitude towards treatment.
Blood Glucose ; Comorbidity ; Diabetes Complications ; Diabetes Mellitus ; Humans ; Hyperglycemia ; Hypoglycemia ; Life Expectancy

Postprandial hyperglycemia is an important factor in the progression of diabetes and related complications. To reduce the burden of the diabetes epidemic in Korea, a better understanding of the pathophysiology of postprandial hyperglycemia is needed as well as optimal treatment modalities based on individual characteristics of the patient. The standard oral glucose tolerance test can be used to identify those at high risk for diabetes and cardiovascular disease. In the treatment of postprandial hyperglycemia, physicians should provide lifestyle modification support as well as appropriate pharmacological treatment, such as incretin-based therapies. Further clinical trials using recently developed anti-diabetic treatments focusing on postprandial hyperglycemia are needed to evaluate the effectiveness of targeting postprandial hyperglycemia in order to prevent diabetes and diabetes complications.
Cardiovascular Diseases ; Diabetes Complications ; Diabetes Mellitus ; Glucose Tolerance Test ; Humans ; Hyperglycemia* ; Korea ; Life Style

The high incidence of atherosclerosis and cardiovascular disease is the leading cause of morbidity and mortality among diabetic patients. It is well known that postprandial hyperglycemia is an independent risk factor for diabetic complications and mortality. For better management of diabetic patients, effort must be put forth to not only achieve the HbA1c target, but also to control postprandial hyperglycemia. This article reviews the pathophysiology and clinical aspects of postprandial hyperglycemia to appropriately control blood glucose level.
Atherosclerosis ; Blood Glucose ; Cardiovascular Diseases ; Diabetes Complications ; Hemoglobin A, Glycosylated ; Humans ; Hyperglycemia ; Incidence ; Risk Factors