Is Glycemic Variability Linked to Microvascular Complications in Type 1 Diabetes Patients?

Within-day glycemic variability likely does not affect the development of microvascular complications in patients with type 1 diabetes, a recent study showed. However, results indicated that glycemic variability likely affects this development over time.

The Diabetes Control and Complications Trial (DCCT) investigated glucose variability within and between quarterly 7-point glucose profiles with the development and progression of retinopathy, nephropathy, and cardiovascular autonomic neuropathy in participants with type 1 diabetes.
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The researchers used Cox proportional hazards models to evaluate the association of each measure of glycemic variation with the risk of retinopathy and nephropathy. Additionally, the researchers used a longitudinal logistic regression model to measure the association of each measure with the risk of cardiovascular autonomic neuropathy.

After adjusting for mean blood glucose, the researchers found no association between any within-day glycemic variability measure and any outcome. Only the longitudinal mean M-value (over time) had a significant link to microalbuminuria. The Holm procedure was used to adjust for the longitudinal mean blood glucose and to correct for multiple tests.

“Overall, within-day glycemic variability, as determined from quarterly glucose profiles, does not play an apparent role in the development of microvascular complications beyond the influence of the mean glucose,” the researchers concluded.

—Christina Vogt

Reference:

Lachin JM, Bebu Ionut, Bergenstal RM, et al. Association of glycemic variability in type 1 diabetes with progression of microvascular outcomes in the diabetes control and complications trial. Diabetes Care. 2017;40(6):777-783. doi:10.2337/dc16-2426.