The effects of fasting plasma glucose variability and time-dependent glycemic control on the long-term risk of retinopathy in type 2 diabetic patients

Takao, Toshiko; Ide, Takehiko; Yanagisawa, Hiroyuki; Kikuchi, Masatoshi; Kawazu, Shoji; Matsuyama, Yutaka

doi:10.1016/j.diabres.2010.10.009

Cited by 31 publications

(18 citation statements)

References 9 publications

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“…We found that higher fasting glucose variability was independently correlated with the development of new‐onset PDR and DMO after adjustment for the baseline and mean follow‐up fasting glucose levels. Our finding is consistent with that of many previous studies that showed fasting glucose variability as a significant risk factor for the onset of DR in type 2 diabetes, although those studies were of smaller scales or shorter terms . On the other hand, the relationship of DMO with glycaemic variability has not been explored previously.…”

Section: Discussionsupporting

confidence: 92%

“…For type 1 diabetes, some large‐scale longitudinal studies showed that a higher HbA1c variability was associated with an increased risk of DR, although no specific relationship between glucose variability and DR was found . On the contrary, in type 2 diabetic patients, more studies found that fasting glucose variability was a significant risk factor for the onset of DR, although these were mostly small‐scale and/or short‐term studies . Although a larger‐scale study followed 746 patients with type 2 diabetes for 1.6 ± 1.0 years showed no significant relationship between glucose variability and the development of DR, there have been no large‐scale, long‐term studies that investigated the effect of glycaemic variability on DR up to now.…”

Section: Introductionmentioning

confidence: 98%

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Fasting plasma glucose variability is an independent risk factor for diabetic retinopathy and diabetic macular oedema in type 2 diabetes: An 8‐year prospective cohort study

Hsieh

2020

Clinical Exper Ophthalmology

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Importance: Long-term stability in plasma glucose may affect the development of diabetic retinopathy (DR) and diabetic macular oedema (DMO).Background: To investigate the associations between glycaemic variability and the development of DR and DMO in type 2 diabetes (T2D).Design: An 8-year prospective cohort study. Participants: 2005 patients with T2D.Methods: DR and DMO were detected with non-mydriatic fundus photography. Main outcome measures:The visit-to-visit variability of fasting glucose or HbA1c was calculated as the standard deviation (SD) or coefficient of variation (CV = SD/mean) of all records during the follow-up periods or before the onset of the targeted event. Cox regression analysis was used to evaluate the hazard ratios (HRs) for new-onset DR, proliferative diabetic retinopathy (PDR), and DMO.Results: After adjusting for the baseline and mean follow-up values, the SD and CV of fasting glucose during the follow-up periods were both correlated with the development of PDR (SD: HR = 1.011, P = .005; CV: HR = 6.858, P < .001), and DMO (SD: HR = 1.008, P = .038; CV: HR = 4.027, P = .017). As for HbA1c, neither the SD nor CV was correlated with the development of DR, PDR, or DMO (P > .05 for all). Conclusions and relevance:High visit-to-visit fasting glucose variability was associated with new-onset PDR and DMO, independent of baseline and mean follow-up fasting glucose and HbA1c in T2D. Long-term stability in plasma glucose is important for reducing the risk of the development and progression for DR and DMO. K E Y W O R D Sdiabetes mellitus, diabetic macular oedema, diabetic retinopathy, glycaemic variability

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 98%

Fasting plasma glucose variability is an independent risk factor for diabetic retinopathy and diabetic macular oedema in type 2 diabetes: An 8‐year prospective cohort study

Hsieh

2020

Clinical Exper Ophthalmology

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“…Most of those studies that investigated the risk of retinopathy reported positive associations (4,6,7). An Italian population-based prospective cohort study also demonstrated a positive association between VVV in fasting glucose and all-cause mortality (24).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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The effects of fasting plasma glucose variability and time-dependent glycemic control on the long-term risk of retinopathy in type 2 diabetic patients

Cited by 31 publications

References 9 publications

Fasting plasma glucose variability is an independent risk factor for diabetic retinopathy and diabetic macular oedema in type 2 diabetes: An 8‐year prospective cohort study

Fasting plasma glucose variability is an independent risk factor for diabetic retinopathy and diabetic macular oedema in type 2 diabetes: An 8‐year prospective cohort study

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

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

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