Fasting blood sugar variation predicts Microvascular complications in diabetes
Patients with type 2 diabetes are at high risk of fatal and non-fatal myocardial infarction and stroke. Researchers of Arizona have reported that Variation in Fasting blood sugar level is an independent marker of microvascular risk in patients with Type 2 Diabetes. The research findings were published in The Journal of Clinical Endocrinology & Metabolism on December 25, 2020.
Optimal blood sugar control is fundamental to the management of diabetes. Regardless of the underlying treatment, glycated hemoglobin (A1C) levels >7.0% are associated with a significantly increased risk of both microvascular and cardiovascular (CV) complications. Chronic hyperglycemia increases CV risk and post-challenge/postprandial hyperglycemia has been associated with CVD independent of A1C or fasting blood glucose (FBG). However, the association of blood sugar variability with microvascular disease complications in type 2 diabetes (T2D) has been understudied and remains unclear. Therefore researchers conducted a study to investigate this relationship using both Action to Control Cardiovascular Risk in Diabetes (ACCORD) and the Veteran Affairs Diabetes Trial (VADT).
It was a posthoc analysis of data from ACCORD and VADT trial. In ACCORD, fasting plasma glucose (FPG) was measured 1-3 times/year for up to 84 months in 10,251 individuals. In the VADT, FPG was measured every 3 months for up to 87 months in 1,791 individuals. For fasting glucose, variabilities measured were the coefficient of variation (CV) and average real variability (ARV). The major outcome assessed was the time to either severe nephropathy or retinopathy event and secondary outcomes included each outcome individually. For assessing the association, researchers considered variability measures as time-dependent covariates in Cox proportional hazard models. They conducted a meta-analysis in both the trials to estimate the risk of fasting glucose variability and to assess the heterogenous effects of FPG variability across treatment arms.
Upon analysis of data from both trials, they found that the coefficient of variability and average real variability of fasting plasma glucose was associated with the development of future microvascular outcomes even after adjusting for other risk factors, including measures of average glycemic control. Similarly, Meta-analyses of these two trials also confirmed the association and indicated FPG variation may be more harmful in those with less intensive glucose control.
The authors concluded, "This posthoc analysis indicates that variability of FPG plays a role in, and/or is an independent and readily available marker of, development of microvascular complications in T2D".
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