MAGE represents “mean amplitude of
glucose excurstions” – in other words, the magnitude of
the glucose rise and fall throughout the day. With A1c
held constant, those with greater glucose VARIABILITY
are at increased risk of developing microvascular
Soupal et al.
Diabetes Technology & Therapeutics. 16:4, 2014.
“Patients with any
microvascular complications (MVC) had
significantly higher glucose variability (based
on CGM) than patients without MVC, but
Macrovascular disease risk also
increases along with postprandial hyperglycemia, with a
particular jump in risk when postprandial glucose is
routinely above 200 mg/dl.
And in this
study, in patients with equivalent
A1c, increased postprandial hyperglycemia (as measured
by Glycomark) are at greater risk of experiencing
dementia. This applies to people with varying levels of
Dementia Risk (based on A1c
Rawlings et al. Diabetes
Care, published online 5/12/17
Acute Hyperglycemia: Proposed Mechanism of Damage
Let's take a look at the psychological costs of diabetes.
On top of the
financial burden endured by people with diabetes, there are huge losses in their
mental health world. We don’t have statistics on the increased rates for missed
work, divorce, and relationship conflict which are directly related to diabetes
management… but we do have study data showing that people with diabetes are
likely to suffer from higher rates of depression. Those rates are 2-3 times
their counterparts who do not have diabetes, and 4 times the national average
for rates of anxiety. They’re also three times higher than the national
for disordered eating and eating disorder diagnosis. In fact, research found
that 55% of respondents with type 1 diabetes experienced clinically diagnosable
levels of anxiety, and 46% experienced symptoms that could be diagnosed as acute
depression. 50% experienced increased fatigue to the point where they were
unable to fulfill activities of daily living at some point during their
diagnosis. While at the same time less than 25% of respondents reported ever
having sought treatment for mental health needs.
But there is no
reason that diabetes has to be a disease with crippling mental health struggles.
So let’s take a
look at these specific struggles and how we can help.
exact mechanism by which postprandial glucose excursions affect blood
vessel health is not entirely understood. However, it is believed to be
due to a combination of oxidative stress, abnormal coagulation factors,
and damage to the endothelial lining of blood vessels.