Effect of glucose variability on the long-term risk of microvascular complications in type 1 diabetes
Eric S Kilpatrick, Alan S Rigby, Stephen L Atkin, Eric S Kilpatrick, Alan S Rigby, Stephen L Atkin
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.
References
- Service FJ, O'Brien PC: The relation of glycaemia to the risk of development and progression of retinopathy in the Diabetic Control and Complications Trial. Diabetologia 2001;44:1215–1220
- Kilpatrick ES, Rigby AS, Atkin SL: The effect of glucose variability on the risk of microvascular complications in type 1 diabetes. Diabetes Care 2006;29:1486–1490
- Kilpatrick E, Rigby A, Atkin S: A1C variability and the risk of microvascular complications in type 1 diabetes: data from the Diabetes Control and Complications Trial. Diabetes Care 2008;31:2198–2202
- The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med 2000;342:381–389
- The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA 2002;287:2563–2569
- The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA 2003;290:2159–2167
- The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Epidemiology of Diabetes Interventions and Complications (EDIC): design, implementation, and preliminary results of a long-term follow-up of the Diabetes Control and Complications Trial cohort. Diabetes Care 1999;22:99–111
- Service FJ, Molnar GD, Rosevear JW, Ackerman E, Gatewood LC, Taylor WF: Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes 1970;19:644–655
- Kilpatrick ES, Rigby AS, Atkin SL: Mean blood glucose compared with HbA1c in the prediction of cardiovascular disease in patients with type 1 diabetes. Diabetologia 2008;51:365–371
- Liang K, Zeger S: Longitudinal data analysis using generalized linear models. Biometrika 1986;73:13–22
- Diggle PJ, Heagerty P, Liang K-Y, Zeger SL: Analysis of Longitudinal Data. New York, Oxford University Press, 2002.
- Horton N, Lipsitz S: Review of software to fit generalized estimating equation regression models. The American Statistician 1999;53:160–169
- White NH, Sun W, Cleary PA, Danis RP, Davis MD, Hainsworth DP, Hubbard LD, Lachin JM, Nathan DM: Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial. Arch Ophthalmol 2008;126:1707–1715
Source: PubMed