Extreme Blood Sugar Swings in Patients with Type 2 Diabetes Suspected Trigger for Increased Risk of Heart Disease (Medicine)

In patients with type 2 diabetes, big swings in blood sugar levels between doctors’ visits are associated with an increased risk of heart disease. 

The study, published in the journal Diabetes, Obesity & Metabolism, looked at more than 29,000 patients with type 2 diabetes over a two-year period. Patients who already had heart disease were excluded. 

The American Diabetes Association recommends adults with diabetes maintain an A1c, the average blood sugar level over the past two to three months, of less than 7 percent to reduce complications from diabetes, such as heart disease. However, studies – including this one — have shown that wide swings in blood sugar levels may be a better predictor of diabetic complications than the A1c reading at any single doctor’s office visit. 

“The underlying mechanism for the relationship between wide variations in blood sugar levels between doctor’s appointments and high risk of heart disease in patients with type 2 diabetes is unclear,” said Gang Hu, MD, PhD, Associate Professor and Director, Chronic Disease Epidemiology Lab at Pennington Biomedical Research Center. “It’s possible that episodes of severely low blood sugar may be the connection.”

Research has shown that wide variations in blood sugar levels are associated with poor health outcomes and even death. A 2017 Johns Hopkins study found that one-third of people with diabetes hospitalized for a severe low blood sugar episode died within three years of the incident.

“We recommend that patients and their doctors implement therapies that can reduce wide swings in blood sugar levels and the associated episodes of severe low blood sugar,” Dr. Hu said. “Our findings suggest that measuring the swings in blood hemoglobin A1c levels over a specific time – six months to a year, for example – could serve as a supplemental blood sugar target,” he added. 

This work was funded by the Patient-Centered Outcomes Research Institute. PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit www.pcori.org.

Several authors from Pennington Biomedical Research Center were partly supported by award U54GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


Reference: Shen, Y, Zhou, J, Shi, L, et al. Association between visit‐to‐visit HbA1c variability and the risk of cardiovascular disease in patients with type 2 diabetes. Diabetes Obes Metab. 2021; 23: 125– 135. https://doi.org/10.1111/dom.14201


Provided by LSU Pennington Biomedical Research Center


About LSU’s Pennington Biomedical Research Center

LSU’s Pennington Biomedical Research Center is at the forefront of medical discovery as it relates to understanding the triggers of obesity, diabetes, cardiovascular disease, cancer and dementia. The center conducts basic, clinical and population research, and is affiliated with Louisiana State University. The research enterprise at Pennington Biomedical includes over 450 employees within a network of 40 clinics and research laboratories, and 13 highly specialized core service facilities. Its scientists and physician/scientists are supported by research trainees, lab technicians, nurses, dietitians and other support personnel. Pennington Biomedical is located in state-of-the-art research facilities on a 222-acre campus in Baton Rouge, Louisiana.

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