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HbA(1c) variability is associated with an increased risk of retinopathy requiring laser treatment in type 1 diabetes.
MedLine Citation:
PMID:  23314044     Owner:  NLM     Status:  Publisher    
AIMS/HYPOTHESIS: This study aimed to investigate whether variation in long-term glycaemia in type 1 diabetes as measured by HbA(1c) variability is associated with the cumulative incidence and risk of retinopathy requiring laser treatment. METHODS: The effect of HbA(1c) variability was assessed in 2,019 Finnish Diabetic Nephropathy (FinnDiane) study patients. The patients were studied in two partially overlapping subcohorts with either verified first laser treatment (n = 1,459) or retinopathy severity graded from ophthalmic records with the Early Treatment of Diabetic Retinopathy Study (ETDRS) scale (n = 1,346). The ratio of intrapersonal SD and mean of serially measured HbA(1c) was considered an estimate of HbA(1c) variability. RESULTS: A subcohort of 1,459 patients did not have laser treatment prior to the first FinnDiane visit and 174 of these patients were treated during a mean follow-up period of 5.2 ± 2.2 years. The 5 year cumulative incidence of laser treatment was 19% (95% CI 15, 24) in the highest quartile of HbA(1c) variability and 10% (95% CI 7, 12) in the lowest quartile (p < 0.001, Gray's test) with a corresponding HR of 1.6 (95% CI 1.1, 2.5; p = 0.02) adjusted for renal status, diabetes duration, mean HbA(1c), blood pressure, sex and number of HbA(1c) measurements. In a subcohort of 1,346 patients, 434 patients had proliferative diabetic retinopathy (PDR). Patients in the highest quartile of HbA(1c) variability had an increased risk of PDR compared with the lowest quartile (HR 1.7 [95% CI 1.3, 2.2]; p < 0.001]). CONCLUSIONS/INTERPRETATION: HbA(1c) variability was associated with an increased cumulative incidence and risk of retinopathy requiring laser treatment in type 1 diabetes.
K Hietala; J Wadén; C Forsblom; V Harjutsalo; J Kytö; P Summanen; P-H Groop;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-13
Journal Detail:
Title:  Diabetologia     Volume:  -     ISSN:  1432-0428     ISO Abbreviation:  Diabetologia     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0006777     Medline TA:  Diabetologia     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, University of Helsinki, PO Box 63, Haartmaninkatu 8, FIN-00014, Helsinki, Finland.
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