Er Eren, Ata Aysun, Evin Ferda, Altınok Yasemin Atik, Demir Günay, Özen Samim, Darcan Şükran, Gökşen Damla
Department of Pediatrics, Faculty of Medicine, Division of Pediatric Endocrinology, School of Medicine, Ege University, İzmir, Turkey.
J Pediatr Endocrinol Metab. 2020 Nov 19;33(12):1533-1537. doi: 10.1515/jpem-2020-0337. Print 2020 Dec 16.
Glycated hemoglobin (HbA1c) has proven to be indicative in the development of microvascular complications. In this study, the contribution of HbA1c variability to microvascular complications was evaluated.
Twenty-one cases with type 1 diabetes mellitus (T1DM) who developed microvascular complications and 39 cases without complications, that were similar in terms of gender, age of diagnosis, insulin treatment, insulin doses (U/kg), and mean HbA1c levels were included.
Mean age of T1DM diagnosis was 5.87 ± 3.93 years in the complication group and 4.63 ± 3.33 years in the control group. Nephropathy was detected in 17 cases, neuropathy in 8 cases, and retinopathy in 1 case. Nephropathy occurred at a mean age of 11.52 ± 4.12 years and neuropathy at 14.13 ± 5.68 years. The mean HbA1c during follow-up was similar in the group with complications and the control group (8.60 ± 0.63 vs. 8.84 ± 1.32). Adjusted HbA1c-standard deviation (SD) and HbA1c-variation coefficient (CV) values were 1.30 ± 0.65 and 14.36 ± 6.23 in the group with complications (p=0.014), and 0.91 ± 0.37 and 10.59 ± 4.01 in the control group (p=0.013). In the Receiver Operating Characteristic (ROC)-analysis for microvascular complications, the limit value HbA1c-CV was 11.99 (sensitivity: 61.9%, specificity: 71.9%). This value for HbA1c-SD was 0.9699 (sensitivity: 71.43%, specificity: 66.67%).
This study has shown that long-term fluctuations in HbA1c are associated with the development of microvascular complications in type 1 diabetes.
糖化血红蛋白（HbA1c）已被证明可指示微血管并发症的发生。本研究评估了HbA1c变异性对微血管并发症的影响。
纳入21例发生微血管并发症的1型糖尿病（T1DM）患者和39例无并发症的患者，两组在性别、诊断年龄、胰岛素治疗、胰岛素剂量（U/kg）和平均HbA1c水平方面相似。
并发症组T1DM诊断的平均年龄为5.87±3.93岁，对照组为4.63±3.33岁。检测到17例肾病、8例神经病变和1例视网膜病变。肾病发生的平均年龄为11.52±4.12岁，神经病变为14.13±5.68岁。并发症组和对照组随访期间的平均HbA1c相似（8.60±0.63对8.84±1.32）。并发症组调整后的HbA1c标准差（SD）和HbA1c变异系数（CV）值分别为1.30±0.65和14.36±6.23（p=0.014），对照组为0.91±0.37和10.59±4.01（p=0.013）。在微血管并发症的受试者工作特征（ROC）分析中，HbA1c-CV的临界值为11.99（敏感性：61.9%，特异性：71.9%）。HbA1c-SD的该值为0.9699（敏感性：71.43%，特异性：66.67%）。
本研究表明，HbA1c的长期波动与1型糖尿病微血管并发症的发生有关。
