Institute of Population Health, Centre for Primary Care, University of Manchester, Manchester, U.K.
Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, U.K. Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Institute of Primary Care and Health Science, University of Keele, Stoke-on-Trent, U.K.
Diabetes Care. 2015 Dec;38(12):2354-69. doi: 10.2337/dc15-1188.
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.
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.
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.
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.
血糖变异性作为血糖控制的衡量标准正在逐渐兴起，其可能是并发症的可靠预测指标。本系统评价和荟萃分析评估了 1 型和 2 型糖尿病患者的糖化血红蛋白变异性与微血管和大血管并发症及死亡率之间的关系。
在 Medline 和 Embase 中检索（2004-2015 年）描述 1 型和 2 型糖尿病患者糖化血红蛋白变异性与不良结局之间关系的研究。两名评审员独立进行数据提取。根据糖化血红蛋白变异性的测量方法、分析方法和糖尿病类型进行分层，进行随机效应荟萃分析。
有 7 项研究评估了 1 型糖尿病患者的糖化血红蛋白变异性，结果显示糖化血红蛋白变异性与肾脏疾病（风险比 1.56[95%CI 1.08-2.25]，两项研究）、心血管事件（1.98[1.39-2.82]）和视网膜病变（2.11[1.54-2.89]）相关。有 13 项研究评估了 2 型糖尿病患者的糖化血红蛋白变异性。糖化血红蛋白变异性较高与肾脏疾病（1.34[1.15-1.57]，两项研究）、大血管事件（1.21[1.06-1.38]）、溃疡/坏疽（1.50[1.06-2.12]）、心血管疾病（1.27[1.15-1.40]）和死亡率（1.34[1.18-1.53]）的风险增加相关。大多数研究为回顾性研究，缺乏对潜在混杂因素的调整，并且糖化血红蛋白变异性的定义不一致。
糖化血红蛋白变异性与微血管和大血管并发症及死亡率呈正相关，独立于糖化血红蛋白水平，可能在未来的临床风险评估中发挥作用。
