The Effect of HbA1c Variability as a Risk Measure for Microangiopathy in Type 1 Diabetes Mellitus.

Pedro Romero-Aroca,Raul Navarro-Gil,Albert Feliu,Antonio Moreno,Marc Baget-Bernaldiz,Aida Valls

doi:10.3390/diagnostics11071151

Pedro Romero-Aroca, Raul Navarro-Gil + Show 4 more

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https://doi.org/10.3390/diagnostics11071151

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Abstract

Background: To measure the relationship between variability in HbA1c and microalbuminuria (MA) and diabetic retinopathy (DR) in the long term. Methods: A prospective case-series study, was conducted on 366 Type 1 Diabetes Mellitus patients with normoalbuminuria and without diabetic retinopathy at inclusion. The cohort was followed for a period of 12 years. The Cox survival analysis was used for the multivariate statistical study. The effect of variability in microangiopathy (retinopathy and nephropathy) was evaluated by calculating the standard deviation of HbA1c (SD-HbA1c), the coefficient of variation of HbA1c (CV-HbA1c), average real variability (ARV-HbA1c) and variability irrespective of the mean (VIM-HbA1c) adjusted for the other known variables. Results: A total of 106 patients developed diabetic retinopathy (29%) and 73 microalbuminuria (19.9%). Overt diabetic nephropathy, by our definition, affected only five patients (1.36%). Statistical results show that the current age, mean HbA1c, SD-HbA1c and ARV-HbA1c are significant in the development of diabetic retinopathy. Microalbuminuria was significant for current age, mean HbA1c, CV-HbA1c and ARV-HbA1c. Conclusions: By measuring the variability in HbA1c, we can use SD-HbA1c and ARV-HbA1c as possible targets for judging which patients are at risk of developing DR and MA, and CV-HbA1c as the target for severe DR.

Highlights

It is estimated that 415 million people worldwide were living with some form of diabetes in 2015 [1] and that number has been predicted to rise to around 640 million by 2040 [2]
The results of the present study show that current age is a risk factor in the development of diabetic retinopathy (DR) and MA, which might be due to the duration of Diabetes Mellitus (DM), a well-known risk factor in the development of microangiopathy
Long-term glycaemic variability emerges as a target that needs to be corrected in order to avoid complications in Diabetes Mellitus, such as diabetic retinopathy

Summary

Introduction

It is estimated that 415 million people worldwide were living with some form of diabetes in 2015 [1] and that number has been predicted to rise to around 640 million by 2040 [2]. It has become a chronic disease with several complications. We know that an early form of kidney damage in DM1 patients is microalbuminuria (MA), which is an early-stage diabetic nephropathy. Statistical results show that the current age, mean HbA1c, SD-HbA1c and ARV-HbA1c are significant in the development of diabetic retinopathy. Conclusions: By measuring the variability in HbA1c, we can use SD-HbA1c and ARV-HbA1c as possible targets for judging which patients are at risk of developing DR and MA, and CV-HbA1c as the target for severe DR

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