Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, University of Helsinki, PO Box 63, Haartmaninkatu 8, FIN-00014 Helsinki, Finland.
Diabetologia. 2013 Apr;56(4):737-45. doi: 10.1007/s00125-012-2816-6. Epub 2013 Jan 13.
AIMS/HYPOTHESIS: This study aimed to investigate whether variation in long-term glycaemia in type 1 diabetes as measured by HbA1c variability is associated with the cumulative incidence and risk of retinopathy requiring laser treatment.
The effect of HbA1c variability was assessed in 2,019 Finnish Diabetic Nephropathy (FinnDiane) study patients. The patients were studied in two partially overlapping subcohorts with either verified first laser treatment (n = 1,459) or retinopathy severity graded from ophthalmic records with the Early Treatment of Diabetic Retinopathy Study (ETDRS) scale (n = 1,346). The ratio of intrapersonal SD and mean of serially measured HbA1c was considered an estimate of HbA1c variability.
A subcohort of 1,459 patients did not have laser treatment prior to the first FinnDiane visit and 174 of these patients were treated during a mean follow-up period of 5.2 ± 2.2 years. The 5 year cumulative incidence of laser treatment was 19% (95% CI 15, 24) in the highest quartile of HbA1c variability and 10% (95% CI 7, 12) in the lowest quartile (p < 0.001, Gray's test) with a corresponding HR of 1.6 (95% CI 1.1, 2.5; p = 0.02) adjusted for renal status, diabetes duration, mean HbA1c, blood pressure, sex and number of HbA1c measurements. In a subcohort of 1,346 patients, 434 patients had proliferative diabetic retinopathy (PDR). Patients in the highest quartile of HbA1c variability had an increased risk of PDR compared with the lowest quartile (HR 1.7 [95% CI 1.3, 2.2]; p < 0.001]).
CONCLUSIONS/INTERPRETATION: HbA1c variability was associated with an increased cumulative incidence and risk of retinopathy requiring laser treatment in type 1 diabetes.
目的/假设：本研究旨在探讨 1 型糖尿病患者糖化血红蛋白（HbA1c）变异性与视网膜病变激光治疗累积发生率和风险的关系。
在芬兰糖尿病肾病（FinnDiane）研究的 2019 名患者中评估了 HbA1c 变异性的影响。将患者分为两个部分重叠的亚组进行研究：一组为经证实首次接受激光治疗（n=1459），另一组为根据眼科记录和早期糖尿病视网膜病变研究（ETDRS）量表分级的视网膜病变严重程度（n=1346）。将个体内 HbA1c 测量值的标准差与平均值之比视为 HbA1c 变异性的估计值。
亚组中 1459 名患者在首次 FinnDiane 就诊前未接受激光治疗，其中 174 名患者在平均 5.2±2.2 年的随访期间接受了治疗。在 HbA1c 变异性最高四分位数的患者中，5 年激光治疗累积发生率为 19%（95%CI 15%，24%），而在最低四分位数的患者中为 10%（95%CI 7%，12%）（p<0.001，Gray 检验），经肾脏状况、糖尿病病程、平均 HbA1c、血压、性别和 HbA1c 测量次数调整后，相应的 HR 为 1.6（95%CI 1.1，2.5；p=0.02）。在 1346 名患者的亚组中，434 名患者患有增殖性糖尿病视网膜病变（PDR）。与最低四分位数相比，HbA1c 变异性最高四分位数的患者发生 PDR 的风险增加（HR 1.7 [95%CI 1.3，2.2]；p<0.001）。
1 型糖尿病患者的 HbA1c 变异性与需要激光治疗的视网膜病变的累积发生率和风险增加有关。
