Catherine Gorst1, Chun Shing Kwok2, Saadia Aslam3, Iain Buchan4, Evangelos Kontopantelis5, Phyo K Myint6, Grant Heatlie7, Yoon Loke8, Martin K Rutter9, Mamas A Mamas10. 1. Institute of Population Health, Centre for Primary Care, University of Manchester, Manchester, U.K. catherine.gorst@postgrad.manchester.ac.uk. 2. Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, U.K. Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Institute of Primary Care and Health Science, University of Keele, Stoke-on-Trent, U.K. 3. Central University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K. 4. Farr Institute, University of Manchester, Manchester, U.K. 5. Institute of Population Health, Centre for Primary Care, University of Manchester, Manchester, U.K. 6. Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Aberdeen, Scotland, U.K. 7. Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, U.K. 8. University East Anglia, Norwich, Norfolk, U.K. 9. Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K. Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, U.K. 10. Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, U.K. Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Institute of Primary Care and Health Science, University of Keele, Stoke-on-Trent, U.K. Farr Institute, University of Manchester, Manchester, U.K.
Abstract
OBJECTIVE: Glycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA1c variability and micro- and macrovascular complications and mortality in type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: Medline and Embase were searched (2004-2015) for studies describing associations between HbA1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA1c variability, method of analysis, and diabetes type. RESULTS: Seven studies evaluated HbA1c variability among patients with type 1 diabetes and showed an association of HbA1c variability with renal disease (risk ratio 1.56 [95% CI 1.08-2.25], two studies), cardiovascular events (1.98 [1.39-2.82]), and retinopathy (2.11 [1.54-2.89]). Thirteen studies evaluated HbA1c variability among patients with type 2 diabetes. Higher HbA1c variability was associated with higher risk of renal disease (1.34 [1.15-1.57], two studies), macrovascular events (1.21 [1.06-1.38]), ulceration/gangrene (1.50 [1.06-2.12]), cardiovascular disease (1.27 [1.15-1.40]), and mortality (1.34 [1.18-1.53]). Most studies were retrospective with lack of adjustment for potential confounders, and inconsistency existed in the definition of HbA1c variability. CONCLUSIONS: HbA1c variability was positively associated with micro- and macrovascular complications and mortality independently of the HbA1c level and might play a future role in clinical risk assessment.
OBJECTIVE: Glycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA1c variability and micro- and macrovascular complications and mortality in type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: Medline and Embase were searched (2004-2015) for studies describing associations between HbA1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA1c variability, method of analysis, and diabetes type. RESULTS: Seven studies evaluated HbA1c variability among patients with type 1 diabetes and showed an association of HbA1c variability with renal disease (risk ratio 1.56 [95% CI 1.08-2.25], two studies), cardiovascular events (1.98 [1.39-2.82]), and retinopathy (2.11 [1.54-2.89]). Thirteen studies evaluated HbA1c variability among patients with type 2 diabetes. Higher HbA1c variability was associated with higher risk of renal disease (1.34 [1.15-1.57], two studies), macrovascular events (1.21 [1.06-1.38]), ulceration/gangrene (1.50 [1.06-2.12]), cardiovascular disease (1.27 [1.15-1.40]), and mortality (1.34 [1.18-1.53]). Most studies were retrospective with lack of adjustment for potential confounders, and inconsistency existed in the definition of HbA1c variability. CONCLUSIONS: HbA1c variability was positively associated with micro- and macrovascular complications and mortality independently of the HbA1c level and might play a future role in clinical risk assessment.
Authors: Giada Acciaroli; Giovanni Sparacino; Liisa Hakaste; Andrea Facchinetti; Giorgio Maria Di Nunzio; Alessandro Palombit; Tiinamaija Tuomi; Rafael Gabriel; Jaime Aranda; Saturio Vega; Claudio Cobelli Journal: J Diabetes Sci Technol Date: 2017-06-01
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