Effect of Glucose Variability on the Long-Term Risk of Microvascular Complications in Type 1 Diabetes

  1. Eric S. Kilpatrick, MD, FRCPath1,
  2. Alan S. Rigby, MSC2 and
  3. Stephen L. Atkin, PHD, FRCP3
  1. 1Department of Clinical Biochemistry, Hull Royal Infirmary, Hull, U.K.;
  2. 2Academic Department of Cardiology, University of Hull and Hull York Medical School, Hull, U.K.;
  3. 3Department of Diabetes, Hull York Medical School, Hull, U.K.
  1. Corresponding author: Eric S. Kilpatrick, eric.kilpatrick{at}hey.nhs.uk.

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.

Footnotes

  • The DCCT and its follow-up, the EDIC study, were conducted by the DCCT/EDIC Research Group and supported by National Institutes of Health (NIH) grants and contracts and by the General Clinical Research Center Program, National Center for Research Resources. This article was not prepared under the auspices of the DCCT/EDIC study and does not represent analyses or conclusions of the DCCT/EDIC study group or NIH.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received January 20, 2009.
    • Accepted June 14, 2009.
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  1. Published online before print June 23, 2009, doi: 10.2337/dc09-0109 Diabetes Care October 2009 vol. 32 no. 10 1901-1903
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