The effect of glucose variability on the long-term risk of microvascular complications in type 1 diabetes

doi:10.2337/dc09-0109

The effect of glucose variability on the long-term risk of microvascular complications in type 1 diabetes

Eric S. Kilpatrick, MD, FRCPath, Honorary Professor in Clinical Biochemistry (Eric.Kilpatrick{at}hey.nhs.uk)^a,
Alan S. Rigby, MSc, Senior Lecturer in Statistics and Cardiovascular Epidemiology^b and
Stephen L. Atkin, PhD, FRCP, Professor of Endocrinology and Metabolism^c

^aDepartment of Clinical Biochemistry, Hull Royal Infirmary, Hull
^bAcademic Department of Cardiology, University of Hull and Hull York Medical School, Hull
^cDepartment of Diabetes, Hull York Medical School, Hull, UK

Abstract

Objective: This study analyzed data from Epidemiology of Diabetes Interventions and Complications (EDIC) study to see if 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 (AUC) glucose and the within-day glucose variability (SD and MAGE) during the DCCT was assessed to see how they contributed to the risk of retinopathy and nephropathy by year 4 of EDIC.

Results: Logistic regression showed that the mean glucose during the DCCT and mean HbA_1c during EDIC were independently predictive of retinopathy (each p<0.001) and EDIC HbA_1c of nephropathy (p=0.001) development by EDIC year 4, whereas 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.