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.

Abstract

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.

Citation

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. https://doi.org/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
• Publisher: American Diabetes Association
• Peer Reviewed: Peer Reviewed
• Volume: 32
• Issue: 10
• Pages: 1901-1903
• DOI: https://doi.org/10.2337/dc09-0109
• Keywords: Internal Medicine; Endocrinology, Diabetes and Metabolism; Advanced and Specialised Nursing
• Public URL: https://hull-repository.worktribe.com/output/469893
• Publisher URL: http://care.diabetesjournals.org/content/32/10/1901
• Additional Information: Authors' accepted manuscript of article published in: Diabetes care, 2009, v.32, issue 10
• Contract Date: Nov 13, 2014