Evidence mapPaperPMID 21700921Full record

ArticleDiabetes care2011

Does glucose variability influence the relationship between mean plasma glucose and HbA1c levels in type 1 and type 2 diabetic patients?

Judith C Kuenen, Rikke Borg, Dirk J Kuik, Hui Zheng, David Schoenfeld, Michaela Diamant, David M Nathan, Robert J Heine, ADAG Study Group

Registry-linked trialOpen access · hybridAbstract read
In one paragraph

Article in Diabetes care, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02925559 (Effect of Anti-diabetic Drugs on Glycemic Variability. A Comparison Between Gliclazide MR), which is not on this map. Cited by 33 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 1 pooled it
4.9field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02925559 phase4completedstarted 2016, after this paper: background citation

Effect of Anti-diabetic Drugs on Glycemic Variability. A Comparison Between Gliclazide MR (Modified Release) and Dapagliflozin on Glycemic Variability Measured by Continuous Glucose Monitoring (CGM) in Patients With Uncontrolled Type 2 Diabetes

Ran2016Enrolled135Registered outcomes9Posted comparisons0ConditionsDiabetes Mellitus, Type 2Armsdapagliflozin, Gliclazide MR
Open the trial in the graph
3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 1 synthesis or guideline pooled it, 90 citations in OpenAlex.

  1. Pooled it
  2. Trial
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  6. [Effect of glycemic variability on the efficacy of artificial pancreas systems: A real-world study].Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences · 2026
    Article
  7. Association of HbADiabetologia · 2026
    Article
  8. Review
  9. Article
  10. Article
  11. To What Extent Is HbJournal of clinical medicine · 2024
    Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Review
  18. Article
  19. Glycemic Variability in Type 1 Diabetes Mellitus Saudis Using Ambulatory Glucose Profile.Clinical medicine insights. Endocrinology and diabetes · 2021
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 3 countries.

Judith C KuenenVU University Medical Center, Amsterdam, the Netherlands. jc.kuenen@me.com
Rikke Borg
Dirk J Kuik
Hui Zheng
David Schoenfeld
Michaela Diamant
David M Nathan
Robert J Heine
ADAG Study Group
Amsterdam UMC Location VUmc · NLHarvard University · USMassachusetts General Hospital · USSteno Diabetes Center · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe A1C-Derived Average Glucose (ADAG) study demonstrated a linear relationship between HbA(1c) and mean plasma glucose (MPG). As glucose variability (GV) may contribute to glycation, we examined the association of several glucose variability indices and the MPG-HbA(1c) relationship. RESEARCH DESIGN AND

methodsAnalyses included 268 patients with type 1 diabetes and 159 with type 2 diabetes. MPG during 3 months was calculated from 7-point self-monitored plasma glucose and continuous glucose monitoring. We calculated three different measures of GV and used a multiple-step regression model to determine the contribution of the respective GV measures to the MPG-HbA(1c) relationship.

resultsGV, as reflected by SD and continuous overlapping net glycemic action, had a significant effect on the MPG-HbA(1c) relationship in type 1 diabetic patients so that high GV led to a higher HbA(1c) level for the same MPG. In type 1 diabetes, the impact of confounding and effect modification of a low versus high SD at an MPG level of 160 mg/dL on the HbA(1c) level is 7.02 vs. 7.43 and 6.96 vs. 7.41. All GV measures showed the same tendency.

conclusionsIn only type 1 diabetic patients, GV shows a significant interaction with MPG in the association with HbA(1c). This effect is more pronounced at higher HbA(1c) levels. However, the impact of GV on the HbA(1c) level in type 1 diabetes is modest, particularly when HbA(1c) is close to the treatment target of 7%.

Indexed as

AdolescentAdultAgedBlood GlucoseDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2FemaleGlycated HemoglobinHumansMaleMiddle AgedYoung AdultBlood GlucoseGlycated Hemoglobin

Identifiers

PMID21700921
PMCPMC3142023
OpenAlexW2121976283

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.