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Association of Glycemic Variability in Type 1 Diabetes With Progression of Microvascular Outcomes in the Diabetes

John M Lachin1, Ionut Bebu2, Richard M Bergenstal3

  • 1The Biostatistics Center, The George Washington University, Rockville, MD jml@bsc.gwu.edu.

Diabetes Care
|April 14, 2017
PubMed

Insights

Glycemic variability within a day did not significantly impact microvascular complications in type 1 diabetes. Mean blood glucose levels were the primary factor influencing these diabetes complications.

Area of Science:

  • Endocrinology
  • Diabetology
  • Clinical Research

Background:

  • The Diabetes Control and Complications Trial (DCCT) established that intensive therapy reduces microvascular complications in type 1 diabetes.
  • These benefits were largely attributed to improved HbA1c levels, which correlate with complication risk.

Purpose of the Study:

  • To investigate the association between glucose variability and the development/progression of retinopathy, nephropathy, and cardiovascular autonomic neuropathy.
  • To determine if within-day and between-day glucose fluctuations impact microvascular complications independently of mean glucose levels.

Main Methods:

  • Analysis of quarterly 7-point glucose profiles from the DCCT.
  • Utilized measures of glucose variability including SD, MAGE, and M-value.
  • Employed Cox proportional hazards and longitudinal logistic regression models, adjusting for mean blood glucose.

Main Results:

  • No significant association was found between within-day glycemic variability and any microvascular complication when adjusted for mean blood glucose.
  • Only the longitudinal mean M-value showed a significant association with microalbuminuria after adjustment and correction for multiple testing.

Conclusions:

  • Within-day glucose variability, assessed from quarterly profiles, does not appear to be an independent risk factor for microvascular complications in type 1 diabetes.
  • Mean glucose level remains the dominant factor influencing the development of these complications.
Abstract

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