Lowering average blood glucose levels within the normal range may not significantly improve health outcomes.
Glycemic variability in individuals without diabetes needs further research to understand its implications on health.
Minimizing glucose peaks, even if not meeting the threshold for hyperglycemia, may help reduce the risk of negative health outcomes.
Deep dives
Lower average blood glucose levels may not necessarily be better within the normal range
Research suggests that the idea of lower average blood glucose levels being better for health outcomes within the normal range may not have strong supporting evidence. One study examined the association between hemoglobin A1c (HbA1c) levels and mortality risk over a range of HbA1c categories. The results showed that while there was a significant linear increase in risk with higher HbA1c levels, there were no significant differences in risk within the lower HbA1c range (less than 5% to 5.5%). This suggests that striving for lower HbA1c levels within the normal range may not have significant benefits in terms of health outcomes.
Glycemic variability and its potential impact on health
Glycemic variability refers to fluctuations and swings in blood glucose levels throughout the day, both within a specific day and from day to day. Some studies have found associations between higher glycemic variability and negative health outcomes, particularly in populations with type 2 diabetes or cardiometabolic conditions. However, research specifically focused on glycemic variability in individuals without diabetes is limited. Some studies indicate that factors such as total glucose exposure and dynamics of blood glucose responses may play a role in health outcomes. Further research is needed to better understand the implications of glycemic variability and its potential impact on health in normal glycemic individuals.
Importance of considering the complete glucose response
Studies have highlighted the importance of considering the complete glucose response, beyond just specific time points or individual measures, in assessing health risks. For example, one study looked at the relationship between one-hour and two-hour glucose levels during an oral glucose tolerance test and long-term mortality risk. The results showed that higher mortality risk was observed in individuals with both a high one-hour glucose level and an impaired two-hour response, compared to those with normal levels at both time points. These findings suggest that understanding the dynamics and overall exposure to glucose throughout the testing period may provide valuable insights into health risks. However, more research is needed to fully comprehend the significance of these responses and to establish specific guidelines for healthy glucose responses.
The importance of understanding glycemic variability
Glycemic variability refers to fluctuations in blood glucose levels over time. It is often measured using metrics like standard deviation or continuous overlapping net glycemic action. While glycemic variability has been commonly studied in diabetic populations, it is crucial to distinguish between variability measured from continuous glucose monitoring data and variability assessed through two-hour oral glucose tolerance tests. The research on glycemic variability and its association with outcomes is largely based on long-term measures in individuals with type 2 diabetes. However, these findings may not be directly applicable to normal glycemic individuals.
Importance of minimizing glucose peaks
Minimizing glucose peaks, regardless of average blood glucose or variability levels, is suggested as being beneficial for health. Although this hypothesis is still being explored, research indicates that elevated glucose levels within 30 minutes after a meal, even in the absence of hyperglycemia, may be indicative of underlying beta cell dysfunction. Peaking glucose levels, both in frequency and magnitude, should be minimized to potentially reduce the risk of negative health outcomes. However, the current evidence does not support specific recommendations for target blood glucose levels beyond existing guidelines for fasting and two-hour post-prandial glucose responses.
Often claims are made recommending that people should aim to keep peaks in blood glucose low in terms of both magnitude and frequency.
And while many claims about blood glucose “spikes” are incorrect or purposefully exaggerated to grab attention, there are some reasonable and interesting hypotheses put forward in relation to blood glucose variability and excursions.
For example, interesting questions have been raised in relation to the impact of blood glucose excursions in seemingly normoglycemic and/or healthy people.
In this episode, we look at three specific elements of this: average blood glucose, glucose variability, and glucose peaks. All in the context of people without prediabetes or type diabetes, who have typical blood glucose measures in the ‘normal’ range.
Specifically, we look at three hypothesized recommendations made elsewhere:
“The lower you average blood glucose (HbA1C) is better, even if already in normal range”
“The more you can minimize glucose variability, the better.”
“Minimizing the number of glucose “peaks” is important, even if they don’t meet the threshold for hyperglycemia”
Can normoglycemic people benefit from further reducing these measures? Let’s take a look…
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