Hormonal
Glycemic variability, rather than mean glycemia (HbA1c), is a strong independent prognostic factor for adverse cardiovascular outcomes in type 2 diabetes, driven by oxidative stress and nitric oxide inactivation.
For people with Type 2 Diabetes, managing the ups and downs of blood sugar (glycemic variability) is just as critical, if not more so, than just hitting a target HbA1c number. High variability causes oxidative stress and reduces nitric oxide, damaging blood vessels. Strategies to smooth out glucose levels, such as using DPP-4 inhibitors or dietary modifications that prevent sharp spikes, may offer cardiovascular protection beyond what HbA1c reduction alone achieves.
Glycaemic variability has been shown to be a strong prognostic factor for poorer cardiac outcomes in subjects with T2DM after acute myocardial infarction, supplanting other established measures of glycaemia, including glycated haemoglobin (HbA1c), fasting plasma glucose or postprandial glucose alone [23].
Why this rating
The paper cites meta-analyses and specific clinical trials (e.g., MAGE measurements) supporting the link, though it is a review of observational and trial data rather than a single RCT.
Source
Diabetes, cardiovascular disease and the microcirculation
W. David Strain et al. · Cardiovascular Diabetology · 2018
DOI 10.1186/s12933-018-0703-2
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