Long-Term Glycemic Variability and Vascular Complications in Type 2 Diabetes: Post Hoc Analysis of the FIELD Study.
AIMS
To investigate whether long-term glycemic variability (GV) is associated with vascular complication development in type 2 diabetes.


METHODS
In a post hoc FIELD trial analysis, GV was calculated as the standard deviation and coefficient of variation (CV) of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose. Baseline variables were compared across quartiles of on-study variability by chi square and ANOVA. Prospective associations between baseline to 2-year GV and subsequent vascular and mortality outcomes were analyzed using landmark logistic and Cox proportional hazards regression.


RESULTS
Baseline factors associated with higher on-study GV included younger age, male gender, longer diabetes duration, and higher pharmacological therapies usage. Both HbA1c and fasting glucose CV were associated with increased risk of microvascular complications (HR 1.02 [95% CI, 1.01-1.03] P < 0.01; and HR 1.01 [95% CI, 1.00-1.01] P < 0.001, respectively). HbA1c and fasting glucose CV were associated with increased cardiovascular disease (HR 1.02 [95% CI, 1.00-1.04]; and HR 1.01 [95% CI, 1.00-1.02], both P < 0.05). HbA1c CV associated with increased stroke (HR 1.03 [95% CI, 1.01-1.06) P < 0.01). Glucose CV associated with increased coronary events (HR 1.01 [95% CI, 1.00-1.02] P < 0.05). Both HbA1c and glucose CV associated with increased total mortality (HR 1.04 [95% CI, 1.02-1.06]; and HR 1.01 [95% CI, 1.01-1.02], both P < 0.001) and noncardiovascular mortality (HR 1.05 [95% CI, (1.03-1.07]; and HR 1.02 [95% CI, 1.01-1.03], both P < 0.001). HbA1c CV associated with coronary mortality (HR 1.04 [95% CI, 1.01-1.07] P < 0.05).


CONCLUSIONS
Long-term GV was associated with increased risk of vascular outcomes in type 2 diabetes.
['Scott|Emma S|ES|', 'Januszewski|Andrzej S|AS|', "O'Connell|Rachel|R|", 'Fulcher|Gregory|G|', 'Scott|Russell|R|', 'Kesaniemi|Antero|A|', 'Wu|Linda|L|', 'Colagiuri|Stephen|S|', 'Keech|Anthony|A|', 'Jenkins|Alicia J|AJ|']
D000368:Aged D001315:Australia D000076103:Biological Variation, Individual D001786:Blood Glucose D003924:Diabetes Mellitus, Type 2 D003925:Diabetic Angiopathies D005215:Fasting D005260:Female D005387:Finland D006442:Glycated Hemoglobin A D006801:Humans D008297:Male D008875:Middle Aged D009520:New Zealand D011446:Prospective Studies
glycemic variability vascular complications type 2 diabetes cardiovascular disease stroke HbA1c coefficient of variation glucose coefficient of variation