Initial combination therapy with DPP-IV inhibitors more effectively reduced MAGE than stepwise add-on therapies ( p = 0.006 ) , although no differences in MAGE were found based on HbA1c values .
These findings indicate that DPP-IV inhibitors are promising alternatives for reducing GV in type 2 diabetes patients .
Glycemic variability ( GV ) has been an emerging target for preventing complications related to type 2 diabetes .
For reducing GV , DPP-IV inhibitors have shown effectiveness compared to other oral anti-hyperglycemic drugs ( OADs ) , but systematic evaluation has yet to be existed .
Is HbA(1c) affected by glycemic instability?
OBJECTIVE HbA(1c ) is a st and ard clinical assessment of glycemia and the basis of most data relating glycemic control to complications . It remains unclear , however , whether HbA(1c ) is affected by glycemic variation and mean glycemia . RESEARCH DESIGN AND METHODS To test this question , we analyzed the statistical relationship between HbA(1c ) levels and glycemic variability as measured by self-monitoring of blood glucose ( SMBG ) .  The records of 256 subjects were studied .  SMBG data for the preceding 3 months were downloaded , and HbA(1c ) was measured by ion-exchange high-performance liquid chromatography . Simple- and r and om-effects linear regression models were used to assess the independent contributions of mean blood glucose ( BG ) and SD of BG to HbA(1c ) , after adjusting for the mean BG . RESULTS Mean + /- SD for HbA(1c ) was 7.66 + /- 1.11 % and for BG was 8.5 + /- 1.9 mmol/l ( 153.3 + /- 34.9 mg/dl ) ; SD of BG for individual subjects was 3.5 mmol/l ( 63.3 mg/dl ) , varying from 0.4 mmol/l ( 8.1 mg/dl ; very stable glycemia ) to 8.4 mmol/l ( 152.5 mg/dl ; very unstable glycemia ) . A close correlation between mean BG and HbA(1c ) was demonstrated ( r = 0.62 ) . Also , within-subject SD of BG correlated with HbA(1c ) ( r = 0.375 ) , indicating that people with poorer glycemic control had higher BG variance . After adjusting for mean BG in a linear regression model , however , the effect of the within-subject SD of BG on the HbA(1c ) was insignificant . Several further analyses confirmed the strength of the observation . CONCLUSIONS HbA(1c ) reflects mean glycemia and is not meaningfully affected by glycemic instability after adjusting for mean BG
Initial combination therapy with DPP-IV inhibitors more effectively reduced MAGE than stepwise add-on therapies ( p = 0.006 ) , although no differences in MAGE were found based on HbA1c values .
These findings indicate that DPP-IV inhibitors are promising alternatives for reducing GV in type 2 diabetes patients .
Glycemic variability ( GV ) has been an emerging target for preventing complications related to type 2 diabetes .
For reducing GV , DPP-IV inhibitors have shown effectiveness compared to other oral anti-hyperglycemic drugs ( OADs ) , but systematic evaluation has yet to be existed .