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Effect of glucose variability on the long-term risk of microvascular complications in type 1 diabetes

Kilpatrick, Eric S.; Rigby, Alan S.; Atkin, Stephen L.


Eric S. Kilpatrick

Alan S. Rigby

Stephen L. Atkin


OBJECTIVE This study analyzed data from the Epidemiology of Diabetes Interventions and Complications (EDIC) study to see whether longer-term follow-up of Diabetes Control and Complications Trial (DCCT) patients reveals a role for glycemic instability in the development of microvascular complications.

RESEARCH DESIGN AND METHODS The mean area under the curve glucose and the within-day glucose variability (SD and mean amplitude of glycemic excursions [MAGE]) during the DCCT were assessed to see whether they contributed to the risk of retinopathy and nephropathy by year 4 of the EDIC.

RESULTS Logistic regression analysis showed that mean glucose during the DCCT and mean A1C during EDIC were independently predictive of retinopathy (each P < 0.001) as well as A1C during EDIC of nephropathy (P = 0.001) development by EDIC year 4. Glucose variability did not add to this (all P > 0.25 using SD or MAGE).

CONCLUSIONS Glucose variability in the DCCT did not predict the development of retinopathy or nephropathy by EDIC year 4.

Analysis of the Diabetes Control and Complications Trial (DCCT) dataset has shown that glucose variability did not appear to be a further factor in the development or progression of either retinopathy or nephropathy (1,2). More recently, variability in A1C, a longer-term marker of glycemic control, during the DCCT has been found to add to the risk already indicated by the mean A1C value (3).

This current study has examined data from the first 4 years of the DCCT extension study, the Epidemiology of Diabetes Interventions and Complications (EDIC) study. The EDIC has already shown the long-term beneficial effects of intensive treatment on microvascular complications (4–6). Our goal was to establish whether the follow-up study also unearths a longer-term relationship between glucose variability during the DCCT and subsequent retinopathy and nephropathy.


Kilpatrick, E. S., Rigby, A. S., & Atkin, S. L. (2009). Effect of glucose variability on the long-term risk of microvascular complications in type 1 diabetes. Diabetes Care, 32(10), 1901-1903. doi:10.2337/dc09-0109

Journal Article Type Article
Online Publication Date Jun 23, 2009
Publication Date Oct 1, 2009
Deposit Date Nov 13, 2014
Publicly Available Date Nov 13, 2014
Journal Diabetes care
Print ISSN 0149-5992
Electronic ISSN 1935-5548
Publisher American Diabetes Association
Peer Reviewed Peer Reviewed
Volume 32
Issue 10
Pages 1901-1903
Keywords Internal Medicine; Endocrinology, Diabetes and Metabolism; Advanced and Specialised Nursing
Public URL
Publisher URL
Additional Information Authors' accepted manuscript of article published in: Diabetes care, 2009, v.32, issue 10


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