Understanding the Ups and Downs of Blood Glucose.ppt

“Oxidative Stress”What Should You Know? Oxygen is critical for life: respiration and energy Oxygen is also implicated in many disease processes, ranging from arthritis, cancer, Lou Gehrig’s disease as well as aging This dangerous form of oxygen is from the formation of “free radicals” or “reactive oxygen species”, or pro-oxidants Normally, pro-oxidants are neutralized by anti-oxidants “Oxidative Stress”: What You Should Know Oxidative Stress: Why is it Important? OK, What Turns On Oxidative Stress, Free Radicals, and Reactive Oxygen Species High blood glucose Science is confirmed on this point Variability in blood glucose Science is highly suggestive on this point What We KNOW Risk of complications are related to Glycemic exposure as measured as A1c over time Proven Genetic risks Clearly true, but little understanding Glycemic variability Supported by most but not all studies Conclusion 1 Glycemic variability may be an important mechanism increasing oxidative stress and vascular complications Other Significance of a High SD The Future of Glycemic Variability: Measurements For the Future SD: used with SMBG for over a decade with meter downloads; underutilized Interquartile ratio: the range where the middle 50% of the values in a distribution falls, calculated by subtracting the 25th from the 75th percentile Compared to SD, IQR not influenced by outliers MAGE: gold standard (?) but requires continuous glucose sensing. May be more useful as we move into the CGM era What We Need Conclusions Although there is no definitive proof from a randomized controlled trial, the data suggests that glycemic variability is a risk factor for microvascular complications We have the opportunity to quantitate GV now with meter downloads * * Understanding the Ups and Downs of Blood Glucose Irl B. Hirsch, M.D. University of Washington Question Who has the greatest risk of proliferative diabetic retinopathy (PDR) over the next 10 years A 55 y/o man with type 2 diabetes for 5 years, on or