Long-term glycemic variability and risk of adverse health outcomes in patients with diabetes: A systematic review and meta-analysis of cohort studies
Abstract
Aims To quantify associations of different metrics of long-term glycemic variability (GV) with multiple adverse diabetes-related outcomes. Methods We searched PubMed and Embase from database inception to 23 August 2021. GV was based on measurements of HbA1c or fasting plasma glucose (FPG) and calculated by standard deviation (SD), coefficient of variance (CV) or other metrics. Outcomes included mortality, cardiovascular disease (CVD), renal disease, peripheral neuropathy, retinopathy, dementia and cancer. Random-effects meta-analyses were adopted to pool the relative risks (RRs). Results Seventy-five articles with 2,051,701 participants were included. When comparing top with bottom quartiles, HbA1c variabilities were associated with all-cause mortality (RR CV = 1.63, 95 % CI 1.37-1.92; RR SD = 1.87, 1.55-2.26), CVD (RR CV = 1.38, 1.07-1.78; RR SD = 1.34, 1.12-1.59), renal disease (RR CV = 1.43, 1.18-1.74; RR SD = 1.44, 1.24-1.67), and peripheral neuropathy (RR CV = 1.84, 1.40-2.43; RR SD = 1.98, 1.51-2.61), but not retinopathy. FPG variabilities were associated with all-cause mortality (RR CV = 1.59, 1.43-1.78; RR SD = 1.67, 1.26-2.20), renal disease (RR CV = 1.77, 1.32-2.38), and retinopathy (RR CV = 1.92, 1.10-3.35), but not CVD and peripheral neuropathy. Associations of GV with Alzheimer's disease (RR HbA1c-CV = 1.38, 1.13-1.70; RR FPG-CV = 1.32, 1.07-1.63) and cancer (RR HbA1c-SD = 2.19, 1.52-3.17; RR FPG-CV = 3.64, 2.21-5.98) were each found significant in one study. Con…
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Glycaemic variability is associated with both microvascular and macrovascular complications, with reduced quality of life, and increasing the psychological burden of diabetes management.
“This glycaemic variability, is associated with both microvascular and macrovascular complications, with reduced quality of life, and increasing in the psychological burden of diabetes management [98–100].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [99]
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- Authors
- Chen, J., Yi, Q., Wang, Y., Wang, J., Yu, H., Zhang, J., Hu, M., Xu, J., Wu, Z., Hou, L., Zhang, Z., Zhang, Y., Wang, Y., Tu, Z., Yang, K., Guo, K., Zhou, Y., Geng, T., Pan, X., Liu, G., Song, P., & Pan, A.
- Affiliations
- Huazhong University of Science and Technology (CN)
- Zhejiang University (CN)
- Hubei University of Medicine (CN)
- Women's Hospital, School of Medicine, Zhejiang University (CN)
- Corresponding author
- Chen, Junxiang
- Wang, Yuxiang
- Wang, Jingyi
- Yu, Hancheng
- Zhang, Jijuan
- Hu, Mengyan
- Xu, Jiajing
- Wu, Zixuan
- Hou, Leying
- Zhang, Zhe
- Zhang, Yanbo
- Wang, Yi
- Yang, Kun
- Guo, Kunquan
- Zhou, Yanfeng
- Geng, Tingting
- Liu, Gang
- Song, Peige
- Pan, An
- ORCID
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2022-10
- Volume
- 192
- Pages
- 110085
- ISSN
- 0168-8227 (ISSN-L)
- OpenAlex
- W4296142887
- Cited by
- 69
- References
- 35
- Citations by year
- 2026: 13 · 2025: 19 · 2024: 15 · 2023: 20 · 2022: 1
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Diabetes Research and Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81930124, 82021005)
- Science and Technology Commission of Shanghai Municipality (2017SHZDZX01)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- glycemic variability, diabetes mellitus, HbA1c variability, coefficient of variation, standard deviation, all-cause mortality, cardiovascular disease, diabetic nephropathy, diabetic retinopathy, diabetic peripheral neuropathy, Alzheimer's disease, cancer risk, adverse health effects, long-term glycemic control, retinopathy risk factors, dementia risk
- MeSH terms
- Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Cohort Studies, Outcome Assessment, Health Care
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