Long-Term Problems (cont'd.)

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 complications.

 

Microvascular Complications? A1c SD MAGE Yes 8.6% 73 124 No 8.5% 61 106 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 comparable A1c.”

 

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 A1c.

Dementia Risk (based on A1c and Glycomark)

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 higher than 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 rates 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.

The 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.