554-P: Glycemic Variation Predicts Microvascular Risk in both ACCORD and VADT

Abstract

The relationship of glycemic variability with microvascular disease complications in type 2 diabetes (T2D) is controversial. Using both Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Veteran Affairs Diabetes Trial (VADT), we investigated this relationship. In ACCORD, fasting glucose was measured every 4 months during the first year then annually for up to 84 months in 10251 individuals. In the VADT, fasting glucose were measured every 3 months for up to 87 months in 1791 individuals. Variability measures included coefficient of variation (CV). In Cox proportional hazard models, log CV in both ACCORD and the VADT were associated with development of future microvascular outcomes (composite of nephropathy and retinopathy) even after adjusting for other risk factors, including average glycemic control (Figure 1). Additional adjustment for severe hypoglycemic episodes did not account for the effect of glucose variability. This analysis indicates that variability of fasting glucose may play a role in, and/or is an independent and readily available marker of, development of microvascular complications in T2D. Disclosure J. Zhou: None. P. Reaven: Advisory Panel; Self; Boston Heart Diagnostics. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Funding National Institutes of Health