Long-term glycemic variability and risk of adverse outcomes: a systematic review and meta-analysis

Gorst, Catherine, Kwok, Chun Shing, Aslam, Saadia, Buchan, Iain, Kontopantelis, Evangelos, Myint, Phyo K., Heatlie, Grant, Loke, Yoon, Rutter, Martin K. and Mamas, Mamas A. (2015) Long-term glycemic variability and risk of adverse outcomes: a systematic review and meta-analysis. Diabetes Care, 38 (12). pp. 2354-2369. ISSN 0149-5992

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Abstract

OBJECTIVE: Glycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA1c variability and micro- and macrovascular complications and mortality in type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: Medline and Embase were searched (2004–2015) for studies describing associations between HbA1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA1c variability, method of analysis, and diabetes type. RESULTS: Seven studies evaluated HbA1c variability among patients with type 1 diabetes and showed an association of HbA1c variability with renal disease (risk ratio 1.56 [95% CI 1.08–2.25], two studies), cardiovascular events (1.98 [1.39–2.82]), and retinopathy (2.11 [1.54–2.89]). Thirteen studies evaluated HbA1c variability among patients with type 2 diabetes. Higher HbA1c variability was associated with higher risk of renal disease (1.34 [1.15–1.57], two studies), macrovascular events (1.21 [1.06–1.38]), ulceration/gangrene (1.50 [1.06–2.12]), cardiovascular disease (1.27 [1.15–1.40]), and mortality (1.34 [1.18–1.53]). Most studies were retrospective with lack of adjustment for potential confounders, and inconsistency existed in the definition of HbA1c variability. CONCLUSIONS: HbA1c variability was positively associated with micro- and macrovascular complications and mortality independently of the HbA1c level and might play a future role in clinical risk assessment.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 19 Dec 2015 07:20
Last Modified: 22 Apr 2020 00:47
URI: https://ueaeprints.uea.ac.uk/id/eprint/55807
DOI: 10.2337/dc15-1188

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