Abstract
AimsIncreased visit‐to‐visit glycaemic variability is independently associated with adverse outcomes in Type 2 diabetes. Our aim was to identify the patient characteristics associated with raised visit‐to‐visit glycaemic variability in people with Type 2 diabetes.MethodsA case–control study was conducted to establish associations between HbA1c variability and clinical covariates in 10 130 people with Type 2 diabetes. Variability was calculated by two metrics [sd and coefficient of variation (CV)] from a minimum of four HbA1c readings obtained over a 4‐year period. High and low variability groups were defined as the top and bottom tertile of the sd or CV, and used in logistic regression analyses including a number of clinical and biochemical covariates. The analyses were stratified into low mean (< 53 mmol/mol; 7%) and high mean (≥ 53 mmol/mol; 7%) HbA1c groups.ResultsFindings were consistent across both HbA1c groups and variability metrics. Treatment, independent of other factors, was the most strongly associated covariate for the risk of high HbA1c variability. A six‐fold increased risk was observed in the low HbA1c group, between the most and least intense treatment regimens (P < 0.001). Similar findings were present in the high HbA1c group with a three‐fold increase in risk (P < 0.001). In addition, male gender, younger age, reduced HDL‐cholesterol and increased BMI were all found to be independently associated with raised visit‐to‐visit glycaemic variability.ConclusionsIntensive treatment resulting in low mean HbA1c was associated with marked increase in HbA1c variability. Irrespective of diabetes control, the greatest visit‐to‐visit variability was observed in young, insulin resistant men.
Highlights
Pivotal studies over the years have demonstrated the beneficial effects of lowering HbA1c on both micro- and macrovascular complications in Type 2 diabetes [1,2]
Intensive treatment resulting in low mean HbA1c was associated with marked increase in HbA1c variability
Irrespective of diabetes control, the greatest visit-to-visit variability was observed in young, insulin resistant men
Summary
Pivotal studies over the years have demonstrated the beneficial effects of lowering HbA1c on both micro- and macrovascular complications in Type 2 diabetes [1,2]. On-going debate exists as to whether other factors, such as glycaemic variability, play a contributory role in the adverse outcomes of diabetes. Glycaemic variability is the measure of glycaemic fluctuations over a given time. It is an umbrella term for two distinct measurements: intraday variability (short-term) and visit-to-visit variability (long-term). HbA1c is most often used as the measure of glycaemia in the latter. No ‘gold standard’ metric exists to measure HbA1c variability, it is most commonly expressed as either the standard deviation (SD) or coefficient of variation (CV) of the glycaemia measures
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