Effects of Glycemic Variability on the Progression of Diabetic Retinopathy Among Patients With Type 2 Diabetes

Park, Jae Yong; Hwang, Je Hyung; Kang, Min Ji; Sim, Ha Eun; Kim, Jae Suk; Ko, Kyung Soo

doi:10.1097/iae.0000000000003049

Cited by 12 publications

(18 citation statements)

References 19 publications

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“…Similarly, there are few data on people with type 2 diabetes, and some of those also suggest no relationship [21,22]. However, recent data from a cohort of 1125 people from Park et al have produced data similar to ours, suggesting that mean HbA 1c and HbA 1c standard deviation were associated with a lower risk of retinopathy and retinopathy progression [41]. Our data suggest that there is a relationship for those with type 2 diabeteseven though we have made the assumption that the vast majority of our cohort has type 2 diabetes.…”

Section: Discussionsupporting

confidence: 68%

The Association Between Mean Glycated Haemoglobin or Glycaemic Variability and the Development of Retinopathy in People with Diabetes: A Retrospective Observational Cohort Study

et al. 2021

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Introduction: To determine the association between mean glycated haemoglobin (HbA 1c ) or glycaemic variability and the development of diabetic retinopathy (DR) in people with diabetes.Methods: An observational cohort study with people registered with a DR eye screening service between October 2012 and October 2017. Those who had no DR at the start of the study were followed for a maximum of 5 years. HbA 1c measures were used to calculate HbA 1c variability and mean HbA 1c to assess any relationship between these and the risk of developing new onset DR. Results: A total of 2511 individuals were followed up for up to 5 years. Of these, 542 (21.6%) developed DR. After adjustment, HbA 1c variability was not significantly associated with the development of DR (p = 0.3435). However, the mean HbA 1c was (p \ 0.0001). Those with type 1 diabetes had an odds of 1.63 (95% CI 1.11-2.40) of a retinopathy diagnosis compared to those with type 2 diabetes. Conclusions: We have shown that mean HbA 1c is associated with an increased risk of developing diabetic retinopathy. However, after adjustment for sex, age, diabetes type and the mean, the HbA 1c variability no longer remained significant. Our data suggest that optimizing long-term glycaemic control remains paramount.

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Section: Discussionsupporting

confidence: 68%

The Association Between Mean Glycated Haemoglobin or Glycaemic Variability and the Development of Retinopathy in People with Diabetes: A Retrospective Observational Cohort Study

et al. 2021

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“…One meta-analysis reported that DR was associated with the long-term HbA1c variability in type 1 DM but not in type 2 DM [ 28 ]. However, recent study with a long follow-up period reported that HbA1c variability played an important role in the development of DR when the HbA1c variability was high (>0.75% [ 10 ]; the cutoff value of HbA1c SD was 1.24 [ 9 ]). One longitudinal study in Taiwan that included 3152 type 2 DM patients who were followed-up for at least 2 years showed that HbA1c variability is an independent risk factor for DR. HbA1c variability may play a role in DR development when the mean value of HbA1c variability index is >0.75% [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…One longitudinal study in Taiwan that included 3152 type 2 DM patients who were followed-up for at least 2 years showed that HbA1c variability is an independent risk factor for DR. HbA1c variability may play a role in DR development when the mean value of HbA1c variability index is >0.75% [ 10 ]. The HbA1c standard deviation was associated with a risk of ≥3 steps of progression on the Early Treatment DR Study person scale as well as progression to PDR in a Korean retrospective study that had a follow-up period of more than 5 years [ 9 ]. The optimal cutoff value of the HbA1c SD was 1.24 for PDR and ≥3 steps of progression.…”

Section: Discussionmentioning

confidence: 99%

“…High HbA1c standard deviations were reported as a predictor for DR development in two longitudinal studies with a large sample size among Asians with type 2 DM and long follow-up period [ 9 , 10 ]. In addition, the HbA1c standard deviation may play a greater role in DR development than the mean HbA1c when the HbA1c variation magnitude is wide.…”

Section: Introductionmentioning

confidence: 99%

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Glycemic Gap as a Useful Surrogate Marker for Glucose Variability and Progression of Diabetic Retinopathy

Hsing

Lin

Chen

et al. 2021

JPM

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(1) Background: Recent studies have reported that the glucose variability (GV), irrespective of glycosylated hemoglobin (HbA1c), could be an additional risk factor for the development of diabetic retinopathy (DR). However, measurements for GV, such as continuous glucose monitoring (CGM) and fasting plasma glucose (FPG) variability, are expensive and time consuming. (2) Methods: This present study aims to explore the correlation between the glycemic gap as a measurement of GV, and DR. In total, 2565 patients were included in this study. We evaluated the effect of the different types of glycemic gaps on DR progression. (3) Results: We found that the area under the curve (AUC) values of both the glycemic gap and negative glycemic gap showed an association with DR progression. (4) Conclusions: On eliminating the possible influences of chronic blood glucose controls, the results show that GV has deleterious effects that are associated with the progression of DR. The glycemic gap is a simple measurement of GV, and the predictive value of the negative glycemic gap in DR progression shows that GV and treatment-related hypoglycemia may cause the development of DR. Individual treatment goals with a reasonable HbA1c and minimal glucose fluctuations may help in preventing DR.

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“…Moreover, it has been also suggested that diabetic patients with higher HbA1c variability are more likely to develop dementia [14]. Despite this, previous studies examining the association between HbA1c variability and the risk of DR showed inconsistent results [15][16][17][18][19][20][21][22][23][24][25][26]. In some studies, higher HbA1c variability appeared to be independently associated with DR [21,24,26], while in other studies, the association was not significant [15-20, 22, 23, 25].…”

Section: Introductionmentioning

confidence: 99%

Association Between the Variability of Glycated Hemoglobin and Retinopathy in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis

et al. 2022

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Visit-to-visit variability of glycated hemoglobin (HbA1c) is a marker of long-term glycemic fluctuation, which has been related to increased risk of macrovascular complications in patients with type 2 diabetes mellitus (T2DM). The association between HbA1c variability and retinopathy in patients with T2DM, however, has been inconsistent in previous studies. In order to fully evaluate the above association, we conducted a meta-analysis. Observational studies related to the aim of the meta-analysis were identified by search of PubMed, Web of Science, and Embase databases. Studies with HbA1c variability evaluated as the standard deviation (SD) and/or the coefficients of variation (CV) of HbA1c were included. The results were analyzed using a random-effects model that incorporated potential heterogeneity between studies. Twelve observational studies involving 44 662 T2DM patients contributed to the meta-analysis. Overall, 5150 (11.5%) patients developed retinopathy. Pooled results showed that compared to patients with lower HbA1c variability, T2DM patients with higher HbA1c-SD (relative risk [RR]: 1.48, 95% confidence interval [CI]: 1.24 to 1.78, p<0.001, I2=34%) and higher HbA1c-CV (RR: 1.29, 95% CI: 1.05 to 1.59, p=0.02, I2=0%) were both associated with higher risk of DR. For studies with HbA1c-SD, the association was not significantly affected by study characteristics such as country, study design, mean age, disease duration, adjustment of mean HbA1c, or quality scores (p for subgroup difference all>0.05). In conclusion, higher HbA1c variability may be associated with an increased risk of retinopathy in patients with T2DM.

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Effects of Glycemic Variability on the Progression of Diabetic Retinopathy Among Patients With Type 2 Diabetes

Cited by 12 publications

References 19 publications

The Association Between Mean Glycated Haemoglobin or Glycaemic Variability and the Development of Retinopathy in People with Diabetes: A Retrospective Observational Cohort Study

The Association Between Mean Glycated Haemoglobin or Glycaemic Variability and the Development of Retinopathy in People with Diabetes: A Retrospective Observational Cohort Study

Glycemic Gap as a Useful Surrogate Marker for Glucose Variability and Progression of Diabetic Retinopathy

Association Between the Variability of Glycated Hemoglobin and Retinopathy in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis

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