"Glycemic variability": a new therapeutic challenge in diabetes the critical care setting

Much attention is recently paid to the possibility that oscillating glucose may superimpose to HbA1c levels in determining the risk for diabetic complications. Furthermore, recent evidences suggest glucose variability as worsening factor for the prognosis in the acute care settings. In vitro and in animal studies confirm that oscillating glucose is more dangerous that stable constant high glucose, particularly in activating the pathways involved in the pathogenesis of diabetic complications. The production of free radicals, accompanied by an insufficient increase of the intracellular antioxidant defenses seem to account for this phenomenon. Human studies also confirm that fluctuating glucose produces an increase of free radicals as well as endothelial dysfunction which are worse that those produced by stable high glucose. Avoiding glucose fluctuations in diabetic patients seems to be an emerging challenge in the treatment of diabetes.