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Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes

Anniina Tynjälä1,2,3, Valma Harjutsalo1,2,3, Fanny Jansson Sigfrids1,2,3

  • 1Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.

Cardiovascular Diabetology
|March 4, 2023
PubMed

Insights

Glycaemic variability, measured by HbA1c metrics, is linked to arterial stiffness in type 1 diabetes patients. This association persists independently of average blood glucose levels, highlighting variability as a key cardiovascular risk factor.

Area of Science:

  • Cardiovascular Research
  • Endocrinology
  • Diabetes Mellitus

Background:

  • Long-term glycaemic variability and arterial stiffness are recognized cardiovascular risk factors.
  • Type 1 diabetes (T1D) management aims to mitigate cardiovascular complications.
  • Understanding the interplay between glycaemic control and vascular health in T1D is crucial.

Purpose of the Study:

  • To investigate the association between long-term glycaemic variability and arterial stiffness in adults with type 1 diabetes.
  • To determine if this association is independent of mean HbA1c levels.
  • To explore different metrics of glycaemic variability.

Main Methods:

  • Cross-sectional study of 673 adults with type 1 diabetes.
  • Retrospective analysis of 10-year HbA1c data to calculate variability indices (adj-HbA1c-SD, HbA1c-CV, HbA1c-ARV).
  • Assessment of arterial stiffness using carotid-femoral pulse wave velocity (cfPWV) and augmentation index (AIx).

Main Results:

  • All three HbA1c variability indices significantly correlated with cfPWV and AIx (p < 0.001).
  • Adjusted HbA1c-SD and HbA1c-CV remained significantly associated with cfPWV and AIx (p < 0.05), even after adjusting for mean HbA1c.
  • HbA1c-ARV showed no significant association in fully adjusted models.

Conclusions:

  • An association exists between glycaemic variability and arterial stiffness in type 1 diabetes, independent of mean HbA1c.
  • Multiple HbA1c variability metrics should be considered when assessing cardiovascular risk in T1D.
  • Further longitudinal and interventional studies are needed to confirm causality and develop management strategies.
Abstract

Keywords:
Applanation tonometryArterial stiffnessAugmentation indexCardiovascular diseaseGlycaemic variabilityHbA1cPulse wave velocityType 1 diabetes

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