Is fasting glucose variability a risk factor for retinopathy in people with type 2 diabetes?

Zoppini, Giacomo; Verlato, Giuseppe; Targher, Giovanni; Casati, Stefano; Gusson, Elena; Biasi, Valeria; Perrone, Fabrizia; Bonora, Enzo; Muggeo, Michele

doi:10.1016/j.numecd.2008.02.007

Cited by 40 publications

(31 citation statements)

References 20 publications

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“…The outcomes studied in previous observational studies that assessed the effects of VVV in fasting glucose in patients with type 2 diabetes were retinopathy and mortality only (4)(5)(6)(7)24). Most of those studies that investigated the risk of retinopathy reported positive associations (4,6,7).…”

Section: Discussionmentioning

confidence: 99%

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Impact of Visit-to-Visit Glycemic Variability on the Risks of Macrovascular and Microvascular Events and All-Cause Mortality in Type 2 Diabetes: The ADVANCE Trial

et al. 2014

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OBJECTIVEThere is no consensus on the importance of visit-to-visit glycemic variability in diabetes. Therefore, we assessed the effects of visit-to-visit variability (VVV) in HbA 1c and fasting glucose on major outcomes in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) trial. RESEARCH DESIGN AND METHODSADVANCE was a factorial randomized controlled trial of intensive glucose control and blood pressure lowering in patients with type 2 diabetes. VVV in the intensive glucose treatment group was defined using the SD of five measurements of HbA 1c and glucose taken 3-24 months after randomization. Outcomes were combined macro-and microvascular events and all-cause mortality occurring post 24 months. Sensitivity analyses were performed using other indices of variability and in the standard glucose treatment group. RESULTSAmong 4,399 patients in the intensive group, an increase in VVV of HbA 1c was associated with an increased risk of vascular events (P = 0.01) and with mortality (P < 0.001): highest versus lowest tenth hazard ratio (95% CI) 1.64 (1.05-2.55) and 3.31 (1.57-6.98), respectively, after multivariable adjustment. A clear association was also observed between VVV of fasting glucose and increased risk of vascular events (P < 0.001; 2.70 [1.65-4.42]). HbA 1c variability was positively associated with the risk of macrovascular events (P = 0.02 for trend), whereas glucose variability was associated with both macro-and microvascular events (P = 0.005 and P < 0.001 for trend, respectively). Sensitivity analyses using other indices, and patients in the standard glucose treatment group, were broadly consistent with these results. CONCLUSIONSConsistency of glycemic control is important to reduce the risks of vascular events and death in type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

“…Recently, a number of studies have raised concerns about possible adverse effects of visit-to-visit glycemic variability in diabetes (4)(5)(6)(7)(8)(9)(10)(11)(12). Therefore, glycemic variability has the potential to provide additional value in the prediction of future complications in diabetes.…”

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confidence: 99%

Impact of Visit-to-Visit Glycemic Variability on the Risks of Macrovascular and Microvascular Events and All-Cause Mortality in Type 2 Diabetes: The ADVANCE Trial

et al. 2014

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“…Preventing or delaying the development of these complications is very important. Recent evidence shows that glucose fluctuations may influence the development of diabetic complications (1,2), possibly by triggering oxidative stress (3), although the data from the HEART2D trial and the Verona Diabetes Study did not seem to support this (4,5). An association of glucose fluctuation and oxidative stress has been observed in both in vitro cell culture and animal studies (6,7).…”

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confidence: 99%

Glucose Fluctuations in Association With Oxidative Stress Among Children With T1DM: Comparison of Different Phases

Meng¹,

Gong²,

Cao³

et al. 2015

The Journal of Clinical Endocrinology & Metabolism

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“…However, after a mean interval of 1.6 years between the first and second eye evaluation, this study found the magnitude of hyperglycemia (M-FPG) and HbA1c not the FPG-CV as a strong independent predictor for the development and progression of diabetic retinopathy in type 2 diabetes patients. 47 …”

Section: Glucose Variability and Microvascular Complica-tions In Typementioning

confidence: 99%

Glycemic Variability: Clinical and Prognostic Significance

Yu¹,

Lin²,

Huang³

et al. 2015

Diabetes Res Open J

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Minimizing development or progression of chronic diabetic micro and macro-vascular complications has been always the goal of glycemic control. In recent years, much attention has been focused on the possibility that glycemic variability confers an additional risk factor for diabetic complications independent of glycated hemoglobin (HbA1c). Evidence suggests that fluctuating glucose levels produce endothelial dysfunction as well as an increase in free radicals, the key link between hyperglycemia and diabetic complications and that these changes are greater than those produced by sustained hyperglycemia in in vitro and in animal studies. In humans studies, experimental setting also support the hypothesis that plasma glucose fluctuations produce a higher increase in oxidative stress as well as endothelial dysfunction than those produced by sustained hyperglycemia in type 2 diabetes. Moreover, glycemic variability may have a role in the prediction of severe hypoglycemia, which may act as a precipitating factor of diabetic complications. Based on review of available evidence, we advocate decreasing hyperglycemia and diminishing glycemic variability as well as avoiding hypoglycemia in diabetic patients as targets of diabetic therapy. Future trials targeting the influence of the control of plasma glucose fluctuations on the development of diabetic micro-and macro-vascular complications are needed to further strengthen the evidence base.

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Is fasting glucose variability a risk factor for retinopathy in people with type 2 diabetes?

Cited by 40 publications

References 20 publications

Impact of Visit-to-Visit Glycemic Variability on the Risks of Macrovascular and Microvascular Events and All-Cause Mortality in Type 2 Diabetes: The ADVANCE Trial

Impact of Visit-to-Visit Glycemic Variability on the Risks of Macrovascular and Microvascular Events and All-Cause Mortality in Type 2 Diabetes: The ADVANCE Trial

Glucose Fluctuations in Association With Oxidative Stress Among Children With T1DM: Comparison of Different Phases

Glycemic Variability: Clinical and Prognostic Significance

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