Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rua Croton, 72, Jacarepagua, Rio de Janeiro, RJ, CEP: 22750-240, Brazil.
Department of Occupational Therapy, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Cardiovasc Diabetol. 2018 Feb 24;17(1):33. doi: 10.1186/s12933-018-0677-0.
Long-term visit-to-visit glycemic variability is an additional measure of glycemic control. We aimed to evaluate the prognostic value of several measures of glycemic variability for the occurrence of micro- and macrovascular complications, and all-cause mortality in patients with type 2 diabetes.
654 individuals were followed-up over a median of 9.3 years. Glycemic variability (SDs and coefficients of variation of HbA and fasting glycaemia) was measured during the first 12- and 24-months. Multivariate Cox analysis, adjusted for risk factors and mean HbA and fasting glycaemia levels, examined the associations between glycemic variability and the occurrence of microvascular (retinopathy, microalbuminuria, renal function deterioration, peripheral neuropathy) and macrovascular complications [total cardiovascular events (CVE), major adverse CVEs (MACE) and cardiovascular mortality], and of all-cause mortality.
During follow-up, 128 patients had a CVE (96 MACE), and 158 patients died (67 from cardiovascular diseases); 152 newly-developed or worsened diabetic retinopathy, 183 achieved the renal composite outcome (89 newly developed microalbuminuria and 91 deteriorated renal function), and 96 newly-developed or worsened peripheral neuropathy. Glycemic variability, particularly the 24-month parameters either estimated by HbA or by fasting glycemia, predicted all endpoints, except for retinopathy and peripheral neuropathy development/progression, and was a better predictor than mean HbA. Glycemic variability predicted retinopathy development/progression in patients with good glycemic control (HbA ≤ 7.5%, 58 mmol/mol) and predicted new-incident peripheral neuropathy.
Long-term visit-to-visit glycemic variability is an additional and frequently a better glycemic parameter than mean HbA levels for assessing the risk of future development of micro- and macrovascular complications in patients with type 2 diabetes.
长期的血糖变异性是血糖控制的另一种衡量指标。我们旨在评估血糖变异性的几种衡量指标对 2 型糖尿病患者发生微血管和大血管并发症以及全因死亡率的预测价值。
654 名患者的中位随访时间为 9.3 年。在最初的 12 个月和 24 个月期间测量了血糖变异性（HbA 和空腹血糖的标准差和变异系数）。多变量 Cox 分析，调整了危险因素以及平均 HbA 和空腹血糖水平，研究了血糖变异性与微血管（视网膜病变、微量白蛋白尿、肾功能恶化、周围神经病变）和大血管并发症[总心血管事件（CVE）、主要不良心血管事件（MACE）和心血管死亡率]以及全因死亡率之间的关联。
在随访期间，128 名患者发生 CVE（96 名 MACE），158 名患者死亡（67 名死于心血管疾病）；152 名新发生或恶化的糖尿病视网膜病变，183 名达到肾脏复合终点（89 名新发生微量白蛋白尿，91 名肾功能恶化），96 名新发生或恶化的周围神经病变。血糖变异性，尤其是通过 HbA 或空腹血糖估计的 24 个月参数，预测了所有终点，除了视网膜病变和周围神经病变的发生/进展，且优于平均 HbA。血糖变异性预测了血糖控制良好（HbA≤7.5%，58mmol/mol）的患者视网膜病变的发生/进展，以及新发的周围神经病变。
长期的血糖变异性是一种额外的、经常优于平均 HbA 水平的血糖参数，可用于评估 2 型糖尿病患者未来发生微血管和大血管并发症的风险。
