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The Effect of HbA1c Variability as a Risk Measure for Microangiopathy in Type 1 Diabetes Mellitus

Pedro Romero-Aroca1, Raul Navarro-Gil1, Albert Feliu2

  • 1Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), Universitat Rovira & Virgili, 43204 Reus, Spain.

Diagnostics (Basel, Switzerland)
|July 2, 2021
PubMed

Insights

Glycemic variability, measured by HbA1c fluctuations, is linked to diabetic complications. Specific variability metrics like SD-HbA1c and ARV-HbA1c can help identify patients at risk for diabetic retinopathy and microalbuminuria.

Area of Science:

  • Endocrinology and Metabolism
  • Diabetology
  • Ophthalmology

Background:

  • Long-term glycemic control is crucial for preventing diabetic microvascular complications.
  • Understanding the impact of glycemic variability on diabetic retinopathy (DR) and microalbuminuria (MA) is essential for risk stratification.

Purpose of the Study:

  • To investigate the association between long-term HbA1c variability and the development of MA and DR in Type 1 Diabetes Mellitus (T1DM) patients.
  • To identify specific metrics of HbA1c variability that predict the onset of these microvascular complications.

Main Methods:

  • A prospective case-series study followed 366 T1DM patients for 12 years.
  • HbA1c variability was assessed using standard deviation (SD-HbA1c), coefficient of variation (CV-HbA1c), average real variability (ARV-HbA1c), and variability irrespective of the mean (VIM-HbA1c).
  • Cox survival analysis was employed for multivariate statistical analysis, adjusting for known risk factors.

Main Results:

  • Diabetic retinopathy developed in 29% of patients, and microalbuminuria in 19.9%.
  • Age, mean HbA1c, SD-HbA1c, and ARV-HbA1c were significant predictors for DR development.
  • Age, mean HbA1c, CV-HbA1c, and ARV-HbA1c were significant predictors for MA development.

Conclusions:

  • SD-HbA1c and ARV-HbA1c can serve as valuable targets for assessing the risk of developing DR and MA.
  • CV-HbA1c may be a useful metric for identifying patients at risk for severe DR.
Abstract

Keywords:
HbA1c variabilitycoefficient of variation of HbA1cdiabetic retinopathyseverity of diabetic retinopathy

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