(13-06-16) Association Between HbA1c Variability and Risk of Microvascular Complications in Adolescents with Type 1 Diabetes.

Virk SA1,2, Donaghue KC1,3, Cho YH1, Benitez-Aguirre P1, Hing S1, Pryke A1, Chan A1, Craig ME1,2,3.

Abstract
CONTEXT:
There is a paucity of data regarding the association between glycosylated hemoglobin variability (HbA1c) and risk of microvascular complications in adolescents with type 1 diabetes (T1D).
OBJECTIVE:
To investigate the association between HbA1c variability and risk of microvascular complications in adolescents with T1D.
DESIGN:
Prospective cohort study from 1990-2014 (median follow-up 8.1 years).
SETTING:
Tertiary pediatric hospital.
PARTICIPANTS:
1706 adolescents (aged 12-20 minimum diabetes duration 5 years) with median age of 15.9 years [interquartile range 14.3-17.5] and diabetes duration of 8.1 years [6.3-10.8].
MAIN OUTCOME MEASURES:
Glycemic variability was computed as the standard deviation of all HbA1c measurements (SD-HbA1c) after diagnosis. Retinopathy was detected using seven-field fundal photography, renal function assessed using albumin excretion rate (AER), peripheral neuropathy detected using thermal and vibration threshold testing, and cardiac autonomic neuropathy detected using time- and frequency-domain analyses of electrocardiogram recordings. Generalized estimating equations were used to examine the relationship between complications outcomes and HbA1c variability, after adjusting for known risk factors including HbA1c, diabetes duration, blood pressure and lipids.
RESULTS:
In multivariable analysis, SD-HbA1c was associated with early retinopathy (odds ratio [OR] 1.32; 95% CI, 1.00-1.73), albuminuria (OR 1.81; 1.04-3.14), increased log10AER (OR 1.10; 1.05-1.15) and cardiac autonomic neuropathy (OR 2.28; 1.23-4.21), but not peripheral neuropathy.
CONCLUSIONS:
Greater HbA1c variability predicts retinopathy, early nephropathy and cardiac autonomic neuropathy, in addition to established risk factors, in adolescents with type 1 diabetes. Minimizing long term fluctuations in glycemia may provide additional protection against the development of microvascular complications.

Fonte: J Clin Endocrinol Metab. 2016 May 17:jc20153604.

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