Dai Dongjun, Shen Yun, Lu Jingyi, Wang Yufei, Zhu Wei, Bao Yuqian, Hu Gang, Zhou Jian
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China.
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China; Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
J Diabetes Complications. 2021 Sep;35(9):107971. doi: 10.1016/j.jdiacomp.2021.107971. Epub 2021 May 29.
There is a paucity of studies regarding the association between long-term glycemic variability with the risk of diabetic retinopathy (DR) in patients with type 2 diabetes. Therefore, the purpose of this study is to explore the association of glycated albumin (GA) variability and HbA1c variability with the risk of DR in patients with type 2 diabetes.
This prospective cohort study included 315 inpatients with type 2 diabetes (191 males and 124 females) with at least 3 measurements of GA and HbA1c within 2years prior to the baseline investigation. Different GA and HbA1c variability markers were calculated, including CV, variability independent of the mean (VIM), and the average real variability (ARV). Cox proportional hazard regression models were used to explore the association between visit-to-visit variability of GA and HbA1c and the risk of DR.
After an average follow-up of 3.42years, 81 patients developed incident DR. Multivariable-adjusted (diabetes duration, smoking status, systolic blood pressure, albumin to creatinine ratio, triglycerides, using fibrates, and mean HbA1c) hazard ratios of DR associated with each unit increase in GA-CV, GA-VIM, and GA-ARV were 1.05 (95% CI 1.02-1.09), 1.69 (95% CI 1.24-2.32), and 1.13 (95%CI 1.04-1.23), respectively. However, there was no significant association between visit-to-visit HbA1c variability and the risk of DR.
The present study indicated that visit-to-visit variability of GA can predict the risk of incident DR in patients with type 2 diabetes, and the prediction ability is independent of the average HbA1c levels.
关于2型糖尿病患者长期血糖变异性与糖尿病视网膜病变（DR）风险之间关联的研究较少。因此，本研究旨在探讨糖化白蛋白（GA）变异性和糖化血红蛋白（HbA1c）变异性与2型糖尿病患者DR风险之间的关联。
这项前瞻性队列研究纳入了315例2型糖尿病住院患者（男性191例，女性124例），在基线调查前2年内至少进行了3次GA和HbA1c测量。计算了不同的GA和HbA1c变异性标志物，包括变异系数（CV）、独立于均值的变异性（VIM）和平均实际变异性（ARV）。采用Cox比例风险回归模型探讨GA和HbA1c的逐次就诊变异性与DR风险之间的关联。
平均随访3.42年后，81例患者发生了新发DR。在多变量调整（糖尿病病程、吸烟状况、收缩压、白蛋白与肌酐比值、甘油三酯、使用贝特类药物和平均HbA1c）后，GA-CV、GA-VIM和GA-ARV每增加一个单位，DR的风险比分别为1.05（95%CI 1.02-1.09）、1.69（95%CI 1.24-2.32）和1.13（95%CI 1.04-1.23）。然而，HbA1c的逐次就诊变异性与DR风险之间无显著关联。
本研究表明，GA的逐次就诊变异性可预测2型糖尿病患者发生新发DR的风险，且该预测能力独立于平均HbA1c水平。
