Abstract
BackgroundLong-term visit-to-visit glycemic variability is an additional measure of glycemic control. We aimed to evaluate the prognostic value of several measures of glycemic variability for the occurrence of micro- and macrovascular complications, and all-cause mortality in patients with type 2 diabetes.Methods654 individuals were followed-up over a median of 9.3 years. Glycemic variability (SDs and coefficients of variation of HbA1c and fasting glycaemia) was measured during the first 12- and 24-months. Multivariate Cox analysis, adjusted for risk factors and mean HbA1c and fasting glycaemia levels, examined the associations between glycemic variability and the occurrence of microvascular (retinopathy, microalbuminuria, renal function deterioration, peripheral neuropathy) and macrovascular complications [total cardiovascular events (CVE), major adverse CVEs (MACE) and cardiovascular mortality], and of all-cause mortality.ResultsDuring follow-up, 128 patients had a CVE (96 MACE), and 158 patients died (67 from cardiovascular diseases); 152 newly-developed or worsened diabetic retinopathy, 183 achieved the renal composite outcome (89 newly developed microalbuminuria and 91 deteriorated renal function), and 96 newly-developed or worsened peripheral neuropathy. Glycemic variability, particularly the 24-month parameters either estimated by HbA1c or by fasting glycemia, predicted all endpoints, except for retinopathy and peripheral neuropathy development/progression, and was a better predictor than mean HbA1c. Glycemic variability predicted retinopathy development/progression in patients with good glycemic control (HbA1c ≤ 7.5%, 58 mmol/mol) and predicted new-incident peripheral neuropathy.ConclusionsLong-term visit-to-visit glycemic variability is an additional and frequently a better glycemic parameter than mean HbA1c levels for assessing the risk of future development of micro- and macrovascular complications in patients with type 2 diabetes.
Highlights
Long-term visit-to-visit glycemic variability is an additional measure of glycemic control
Current diabetes treatment aims to reducing chronic complications development and progression, mainly by controlling hyperglycemia, high blood pressure (BP) levels and dyslipidemia; and glycemic control is traditionally monitored by serial mean glycated hemoglobin (HbA1c) levels [3]
Our study provided new findings, by showing that the predictive power of H bA1c variability for retinopathy development or progression depends on mean HbA1c levels, being positive in patients with better-controlled diabetes, but absent in those poorly-controlled
Summary
Long-term visit-to-visit glycemic variability is an additional measure of glycemic control. Current diabetes treatment aims to reducing chronic complications development and progression, mainly by controlling hyperglycemia, high blood pressure (BP) levels and dyslipidemia; and glycemic control is traditionally monitored by serial mean glycated hemoglobin (HbA1c) levels [3]. This rationale comes from several trials and observational studies showing that lowering HbA1c reduces the risk of micro- and macrovascular complications [4,5,6]. The concept of glycemic variability has recently emerged as another measure of glycemic control, which might constitute an additive, or even better predictor of diabetic complications than mean HbA1c levels [11, 12]
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