Long-term variability of glycemic markers and risk of all-cause mortality in type 2 diabetes: the Look AHEAD study
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Introduction: Glycemic variability may predict poor outcomes in type 2 diabetes. We evaluated the associations of long-term variability in glycosylated hemoglobin (HbA 1C) and fasting plasma glucose (FPG) with cardiovascular disease (CVD) and death among individuals with type 2 diabetes. Research design and methods: We conducted a secondary, prospective cohort analysis of the Look AHEAD (Action for Health in Diabetes) data, including 3560 participants who attended four visits (baseline, 12 months, 24 months, and 36 months) at the outset. Variability of HbA 1C and FPG was assessed using four indices across measurements from four study visits. Participants without CVD during the first 36 months were followed for incident outcomes including a CVD composite (myocardial infarction, stroke, hospitalization for angina, and CVD-related deaths), heart failure (HF), and deaths. Results: Over a median follow-up of 6.8 years, there were 164 deaths from any cause, 33 CVD-related deaths, 91 HF events, and 340 participants experienced the CVD composite. Adjusted HRs comparing the highest to lowest quartile of SD of HbA 1C were 2.10 (95% CI 1.26 to 3.51), 3.43 (95% CI 0.95 to 12.38), 1.01 (95% CI 0.69 to 1.46), and 1.71 (95% CI 0.69 to 4.24) for all-cause mortality, CVD mortality, CVD composite and HF, respectively. The equivalent HRs for highest versus lowest quartile of SD of FPG were 1.66 (95% CI 0.96 to 2.85), 2.20 (95% CI 0.67 to 7.25), 0.94 (95% CI 0.65 to 1.35), and 2.05 (95% CI 0.80 to 5.31), respectively. Conclusions: A greater variability in HbA 1C was associated with elevated risk of mortality. Our findings underscore the need to achieve normal and consistent glycemic control to improve clinical outcomes among individuals with type 2 diabetes.
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Glycemic variability is associated with mortality in patients with type 2 diabetes.
“Recent clinical data indicate that GV is associated with increased risk of hypoglycemia, microvascular and macrovascular complications, and mortality in patients with diabetes, independently of glycated hemoglobin level.”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [22]
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Glycemic variability and cardiovascular disease in patients with type 2 diabetes
Martinez, M., Santamarina, J., Pavesi, A., Musso, C., & Umpierrez, G. E. (2021) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-002032 · Cited by 155 · see citing works
- Authors
- Kaze, A. D., Santhanam, P., Erqou, S., Ahima, R. S., & Echouffo-Tcheugui, J. B.
- Affiliations
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University (US)
- Brown University (US)
- Corresponding author
- Echouffo-Tcheugui, Justin Basile
- Venue
- BMJ Open Diabetes Research & Care
- Publisher
- BMJ
- Published
- 2020-11
- Volume
- 8
- Issue
- 2
- Pages
- e001753
- ISSN
- 2052-4897 (ISSN-L)
- PMC
- PMC7705503
- OpenAlex
- W3106866975
- Cited by
- 40
- References
- 41
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 8 · 2023: 9 · 2022: 9 · 2021: 9
- FWCI
- 5.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- U.S. Department of Veterans Affairs
- Johns Hopkins University
- Rhode Island Foundation
- Center for AIDS Research, University of Washington
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK072488)
- 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, type 2 diabetes, HbA1c, fasting blood glucose, all-cause mortality, cardiovascular mortality, heart failure, glycemic control, incident cardiovascular events, incident heart failure
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Follow-Up Studies, Humans, Prospective Studies, Risk Factors
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