Implications for Glucose Measures in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Abstract

Each day in the U.S. approximately 5,200 people are diagnosed with diabetes. Thirty-three people with diabetes progress to end-stage renal disease, 230 will have diabetes-related amputations, and 55 will become blind (1). There is a substantial loss of life expectancy, mostly from cardiovascular disease (CVD) (1–3). While it is generally accepted that elevations in glucose concentration (e.g., hyperglycemia) predict micro- and macrovascular outcomes in both type 1 and type 2 diabetes, it is unclear what measure of hyperglycemia is most strongly related to adverse outcomes (1–4). Over the last two decades, there has been much work to define various strategies that reduce the risk of these complications and to what extent targets may maximally reduce the risk of complications such as retinopathy, nephropathy, or CVD. However, the majority of this work used glycated hemoglobin (HbA1c) as a biomarker of the degree of hyperglycemia to predict long-term outcomes such as proteinuria, proliferative retinopathy, myocardial infarction, heart failure, or stroke. Recently, there has been an increasing interest in exploring other biomarkers of glycemia in risk prediction for complications related to morbidity and mortality in people with diabetes (5–8). In this regard, there has been work to explore the relative merits of glycated albumin versus measurement of HbA1c in risk prediction for morbidity and mortality in those with kidney disease (5) and in comparing traditional fasting glucose measures with HbA1c biomarkers for prediction of CVD (6). This has led to the natural question regarding how various measures of glycemia predict risk for both micro- and macrovascular complications related to diabetes. In this issue, Nathan et al. (7) report data from the Diabetes …