HbA1c variability and long-term glycemic control are linked to diabetic retinopathy and glomerular filtration rate in patients with type 1 diabetes and multiethnic background.

Autor: Rosa LCGFD; Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil., Zajdenverg L; Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil., Souto DL; Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil. Electronic address: deborasouto@openlink.com.br., Dantas JR; Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil., Pinto MVR; Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil., Salles GFDCM; Federal University of Rio de Janeiro, Brazil., Rodacki M; Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil.
Jazyk: angličtina
Zdroj: Journal of diabetes and its complications [J Diabetes Complications] 2019 Sep; Vol. 33 (9), pp. 610-615. Date of Electronic Publication: 2019 May 31.
DOI: 10.1016/j.jdiacomp.2019.05.022
Abstrakt: Aim: To evaluate the associations between HbA1c variability and long-term glycemic control with microvascular complications in type 1 diabetes (T1D) patients and multiethnic background.
Methods: T1D adults with ≥10 years of follow-up and ≥ 2 HbA1c measurements were included. Glycemic variability was evaluated by the standard deviation (HbA1c-SD), and coefficient of variation (HbA1c-CV), and glycemic control by mean HbA1c over 10 years. Diabetic retinopathy (DR), increased urinary albumin excretion rate (UAER) and reduced glomerular filtration rate (eGFR) were diagnosed. Cardiac autonomic neuropathy (CAN) was diagnosed by cardiac reflex tests. Associations between glycemic parameters with complications were assessed by multivariate logistic regressions.
Results: 220 patients were included. Simultaneously adjusted for each other, mean HbA1c was independently associated with DR (OR: 2.82; 95%CI: 1.45-5.50), increased UAER (OR: 1.97; 95%CI: 1.14-3.09) and CAN (OR: 4.42; 95%CI: 1.45-13.51); whereas HbA1c-CV was independently associated with DR (OR: 8.93; 95%CI: 1.86-42.87) and reduced eGFR (OR: 7.02; 95%CI: 1.47-35.55).
Conclusions: Long-term glycemic control was associated with DR, increased UAER and CAN, while glycemic variability was additionally associated with DR and impaired renal function; suggesting that both good and stable glycemic status might be important to prevent microvascular complications in T1D patients and multiethnic background.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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