HbA1c Variability as an Independent Risk Factor for Microvascular Complications in Type 1 Diabetes
Yuanjie Mao1,2, Wenjun Zhong3
1Diabetes Institute, Ohio University, Athens, OH, USA.
Insights
Glycemic variability, measured by HbA1c coefficient of variation, significantly increases the risk of microvascular complications in type 1 diabetes. This metric may aid in risk assessment beyond average HbA1c levels.
Area of Science:
- Endocrinology
- Diabetology
- Clinical Research
Background:
- Limited research exists on long-term glycemic variability's impact on type 1 diabetes (T1D) complications.
- This study investigates HbA1c variability's association with microvascular complications in T1D.
Purpose of the Study:
- To assess the relationship between HbA1c variability and incident microvascular complications in T1D.
- To determine if HbA1c variability serves as an independent risk factor for complications.
Main Methods:
- Utilized data from the DCCT/EDIC study (n=1240) in type 1 diabetes patients.
- Categorized patients into quartiles based on HbA1c variability (coefficient of variation).
- Assessed incident microvascular complications over an average follow-up of 20.5 years using multivariable models.
Main Results:
- Higher HbA1c variability correlated with increased incidence of all microvascular complications.
- HbA1c variability was independently associated with higher odds of retinopathy, nephropathy, clinical neuropathy, and autonomic neuropathy.
- The association persisted even after adjusting for mean HbA1c levels, particularly when HbA1c exceeded 7.9%.
Conclusions:
- HbA1c variability is a significant independent predictor of microvascular complications in type 1 diabetes.
- HbA1c variability can potentially supplement mean HbA1c in risk stratification for T1D microvascular complications.
Background:
There are few studies on the role of long-term glycemic variability in complications of type 1 diabetes (T1D). This study was aimed to investigate the associations of HbA1c variability represented by the coefficient of variation of HbA1c with incident microvascular complications in T1D by analyzing the data set from the DCCT/EDIC study.
Methods:
Patients (n = 1240) were divided into four groups by HbA1c variability quartiles. Incident microvascular complications were assessed for a duration of an average of 20.5 years. Multivariable models were performed to examine the associations between HbA1c variability and incident microvascular complications.
Results:
All incident microvascular complications were higher in the fourth quartile of the HbA1c variability group. After adjusting for clinical risk factors, HbA1c variability was positively associated with a higher risk of all diabetic microvascular complications (P < .05). Specifically, it had 1.125 (1.082-1.170), 1.114 (1.074-1.154), 1.061 (1.024-1.099), or 1.088 (1.052-1.125) times higher odds (95% confidence interval [CI]) of having retinopathy, nephropathy, clinical neuropathy, or autonomic neuropathy, independent of mean HbA1c values (P < .05). Furthermore, there were higher incident microvascular complications with higher HbA1c variability when HbA1c value was above the group median of 7.9%, while only higher incident autonomic neuropathy with higher HbA1c variability when HbA1c was below the group median.
Conclusions:
Our results showed a significant independent association between HbA1c variability and the risk of microvascular complications in T1D. HbA1c variability might be a supplemental risk stratification tool to mean HbA1c for microvascular complications in T1D.
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