HbA1c variability is associated with microalbuminuria development in type 2 diabetes: a 7-year prospective cohort study

Abstract

In addition to mean HbA(1c) values, HbA(1c) variability, even measured as early as 2 years, is independently associated with the development of microalbuminuria in patients with type 2 diabetes.

Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis

“…Twenty studies in 87,641 participants met the inclusion criteria. Ten studies included participants from Europe (10,11,14,(16)(17)(18)(19)26,29,35,36), eight from Asia (12,13,15,18,20,24,27,28), four from North America (6,18,23, 25), and one from Australasia (18). The number of participants in each study ranged from 234 to 35,891.…”

“…Thirteen studies included 43,620 participants with type 2 diabetes (12,13,(15)(16)(17)(18)(19)(20)23,24,(26)(27)(28)36). These comprised six retrospective cohort studies (13,15,20,23,28,36), five prospective cohort studies (12,16,17,19,26,27), and two post hoc analyses of randomized controlled trials (18,24).…”

“…These comprised six retrospective cohort studies (13,15,20,23,28,36), five prospective cohort studies (12,16,17,19,26,27), and two post hoc analyses of randomized controlled trials (18,24). All studies used secondary care data apart from one of primary and secondary care data (19) and one of solely U.S. primary care data (23).…”

“…All the studies used some form of adjustment for baseline covariates; however, six did not adjust for baseline diabetes medication (15,19,20,23,24,27), and four did not adjust for baseline hypertension medication (13,16,17,20,27). Of the seven studies that did include hypertension medication (12,15,18,23,24,26,28), two adjusted for ACE inhibitor/angiotensin receptor blocker use (23,24). The definition of glycemic variability, outcome evaluated, and study follow-up and results are shown in Table 3.…”

“…First, unlike short-term glycemic variability, longterm glycemic variability may predict complications in both type 1 and type 2 diabetes (6,(10)(11)(12)(13)(14)(15)(21)(22)(23)(24)(25)(26)(27)(28)(29). Second, HbA 1c is routinely recorded in primary care for both types of diabetes, whereas measures of short-term variability are not (30,31).…”