The Effect of HbA1c Variability as a Risk Measure for Microangiopathy in Type 1 Diabetes Mellitus

Abstract

Background: To measure the relationship between variability in HbA_1c and microalbuminuria (MA) and diabetic retinopathy (DR) in the long term.

Methods: A prospective case-series study, was conducted on 366 Type 1 Diabetes Mellitus patients with normoalbuminuria and without diabetic retinopathy at inclusion. The cohort was followed for a period of 12 years. The Cox survival analysis was used for the multivariate statistical study. The effect of variability in microangiopathy (retinopathy and nephropathy) was evaluated by calculating the standard deviation of HbA_1c (SD-HbA_1c), the coefficient of variation of HbA_1c (CV-HbA_1c), average real variability (ARV-HbA_1c) and variability irrespective of the mean (VIM-HbA_1c) adjusted for the other known variables.

Results: A total of 106 patients developed diabetic retinopathy (29%) and 73 microalbuminuria (19.9%). Overt diabetic nephropathy, by our definition, affected only five patients (1.36%). Statistical results show that the current age, mean HbA_1c, SD-HbA_1c and ARV-HbA_1c are significant in the development of diabetic retinopathy. Microalbuminuria was significant for current age, mean HbA_1c, CV-HbA_1c and ARV-HbA_1c.

Conclusions: By measuring the variability in HbA_1c, we can use SD-HbA_1c and ARV-HbA_1c as possible targets for judging which patients are at risk of developing DR and MA, and CV-HbA_1c as the target for severe DR.

Keywords: HbA1c variability; coefficient of variation of HbA1c; diabetic retinopathy; severity of diabetic retinopathy.