Long-Term Glycemic Variability and Vascular Complications in Type 2 Diabetes: Post Hoc Analysis of the FIELD Study.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Oxford University Press Country of Publication: United States NLM ID: 0375362 Publication Model: Print Cited Medium: Internet ISSN: 1945-7197 (Electronic) Linking ISSN: 0021972X NLM ISO Abbreviation: J Clin Endocrinol Metab Subsets: MEDLINE
    • Publication Information:
      Publication: 2017- : New York : Oxford University Press
      Original Publication: Springfield, Ill. : Charles C. Thomas
    • Subject Terms:
      Biological Variation, Individual*; Blood Glucose/*analysis ; Diabetes Mellitus, Type 2/*blood ; Diabetic Angiopathies/*epidemiology ; Glycated Hemoglobin/*analysis; Aged ; Australia/epidemiology ; Diabetes Mellitus, Type 2/complications ; Fasting/blood ; Female ; Finland/epidemiology ; Humans ; Male ; Middle Aged ; New Zealand/epidemiology ; Prospective Studies
    • Abstract:
      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.
      (Published by Oxford University Press on behalf of the Endocrine Society 2020.)
    • Comments:
      Comment in: J Clin Endocrinol Metab. 2020 Oct 1;105(10):. (PMID: 32772083)
      Comment in: J Clin Endocrinol Metab. 2021 Apr 23;106(5):e2376-e2377. (PMID: 33564886)
    • Contributed Indexing:
      Keywords: type 2 diabetes; HbA1c coefficient of variation; cardiovascular disease; glucose coefficient of variation; glycemic variability; stroke; vascular complications
    • Molecular Sequence:
      ISRCTN ISRCTN64783481
    • Accession Number:
      0 (Blood Glucose)
      0 (Glycated Hemoglobin A)
      0 (hemoglobin A1c protein, human)
    • Publication Date:
      Date Created: 20200809 Date Completed: 20210219 Latest Revision: 20221207
    • Publication Date:
      20240628
    • Accession Number:
      10.1210/clinem/dgaa361
    • Accession Number:
      32766757