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Table 4 Mechanism-based therapeutic strategies for reducing GV

From: Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications

Strategies

Population

Possible mechanisms

References

Non-pharmacological strategies

 CGM

40 patients with T1DM

Minimized the risk of severe hypoglycemia

[104]

 High-intensity interval training and moderate-intensity continuous training

15 inactive overweight or obese women

Decreased endothelial cell damage

[108]

 Aerobic and eccentric exercise

16 healthy subjects

Reduced inflammatory cytokines and oxidative stress markers

[109]

 Low carbohydrate diet

10 patients with T1DM

Resulted in more time in euglycemia, less time in hypoglycemia

[110]

Pharmacological strategies

 Once-weekly trelagliptin and once-daily alogliptin

27 patients with T2DM

Improved glycemic control and reduced GV without inducing hypoglycemia

[114]

 GLP-1 RA with basal insulin

160 patients with T2DM

Lowered hypoglycemia and might contribute to the cardiovascular outcome reduction

[115]

 DPP4 inhibitors combined with metformin

69 patients with T2DM

Reduced GV and hypoglycemia

[116]

 DPP4 inhibitors combined with metformin

34 patients with T2DM

Reduced GV and hypoglycemia

[118]

 Metformin plus vildagliptin

44 patients withT2DM

Attenuated oxidative stress index

[119]

 Empagliflozin as adjunct to insulin

75 patients with T1DM

Decreased glucose exposure and variability and increased time in glucose target range.

[120]

 SGLT2 inhibitors

15 patients with T1DM

Improved TIR and the mean glucose level and SD

[121]

  1. CGM continuous glucose monitoring, T1DM type 1 diabetes mellitus, T2DM type 2 diabetes mellitus, GV glycemic variability, GLP-1 RA glucagon-like peptide 1 receptor agonist, DPP4 dipeptidyl-peptidase 4, SGLT2 sodium–glucose cotransporter 2