The Effect of Glucose Variability on the Risk of Microvascular Complications in Type 1 Diabetes
Response to Kilpatrick et al.
- Louis Monnier, MD1,
- Claude Colette, PHD2,
- Lawrence Leiter, MD3,
- Antonio Ceriello, MD4,
- Markolf Hanefeld, MD5,
- David Owens, MD6,
- Naoko Tajima, MD7,
- Jaakko Tuomiletho, MD8,
- Jaime Davidson, MD9 and
- On Behalf of the PGR Group
- 1Department of Metabolic Diseases, University Hospital of Montpellier, Montpellier, France
- 2Laboratory of Human Nutrition and Atherogenesis, University Institute of Clinical Research, Montpellier, France
- 3Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- 4Clinical Sciences Research Institute, University of Warwick, Coventry, U.K.
- 5Centre for Clinical Studies, Technical University of Dresden, Dresden, Germany
- 6Academic Centre, Diabetes Research Unit, Llandough Hospital, Cardiff, U.K.
- 7JIKEI University School of Medicine, Tokyo, Japan
- 8National Public Health Institute, Helsinki Finland
- 9University of Texas, Dallas, Texas
- Address correspondence to Louis Monnier, MD, Lapeyronie Hospital, 34295 Montpellier Cedex 5, France. E-mail: l-monnier{at}chu-montpellier.fr
In an analysis of the datasets collected in the Diabetes Control and Complications Trial, Kilpatrick et al. (1) reported that mean blood glucose was predictive of microvascular complications in patients with type 1 diabetes, while glucose variability did not appear to be a factor in their development. We question their methodology and thereby also the conclusions. They calculated the variability of within-day blood glucose as the SD around the mean of a seven-point glycemic profile measured at each patient’s quarterly visit. With such a methodology, they have probably not selected major glucose fluctuations, but rather a composite of both major and minor fluctuations, …
