Long-term glycemic variability and vascular complications in type 2 diabetes: post hoc analysis of the field study
Abstract
AIMS: To investigate whether long-term glycemic variability (GV) is associated with vascular complication development in type 2 diabetes. METHODS: In a post hoc FIELD trial analysis, GV was calculated as the standard deviation and coefficient of variation (CV) of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose. Baseline variables were compared across quartiles of on-study variability by chi square and ANOVA. Prospective associations between baseline to 2-year GV and subsequent vascular and mortality outcomes were analyzed using landmark logistic and Cox proportional hazards regression. RESULTS: Baseline factors associated with higher on-study GV included younger age, male gender, longer diabetes duration, and higher pharmacological therapies usage. Both HbA1c and fasting glucose CV were associated with increased risk of microvascular complications (HR 1.02 [95% CI, 1.01-1.03] P < 0.01; and HR 1.01 [95% CI, 1.00-1.01] P < 0.001, respectively). HbA1c and fasting glucose CV were associated with increased cardiovascular disease (HR 1.02 [95% CI, 1.00-1.04]; and HR 1.01 [95% CI, 1.00-1.02], both P < 0.05). HbA1c CV associated with increased stroke (HR 1.03 [95% CI, 1.01-1.06) P < 0.01). Glucose CV associated with increased coronary events (HR 1.01 [95% CI, 1.00-1.02] P < 0.05). Both HbA1c and glucose CV associated with increased total mortality (HR 1.04 [95% CI, 1.02-1.06]; and HR 1.01 [95% CI, 1.01-1.02], both P < 0.001) and noncardiovascular mortality (HR 1.05 [95% CI, (1.03-1.07]; and HR 1.02 [95% CI, 1.01-1.03], both P < 0.001). HbA1c CV associated with coronary mortality (HR 1.04 [95% CI, 1.01-1.07] P < 0.05). CONCLUSIONS: Long-term GV was associated with increased risk of vascular outcomes in type 2 diabetes.
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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 [98]
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 [23]
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Lipoprotein Glycation in Diabetes Mellitus
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Precision Medicine Approaches for Management of Type 2 Diabetes
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- Authors
- Scott, E. S., Januszewski, A. S., O’Connell, R., Fulcher, G., Scott, R., Kesaniemi, A., Wu, L., Colagiuri, S., Keech, A., & Jenkins, A. J.
- Affiliations
- The University of Sydney (AU)
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, Sydney, Australia
- Canterbury District Health Board (NZ)
- Oulu Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland
- Corresponding author
- Keech, Anthony
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2020-08-07
- Volume
- 105
- Issue
- 10
- Pages
- e3638-e3649
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W3047896790
- Cited by
- 70
- References
- 51
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 10 · 2023: 19 · 2022: 12 · 2021: 8 · 2020: 1
- FWCI
- 7.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council
- Juvenile Diabetes Research Foundation Australia
- Royal Australian College of Physicians
- Sydney Medical School Foundation
- 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, vascular complications, microvascular complications, cardiovascular disease, stroke, coronary events, mortality, HbA1c, fasting blood glucose, coefficient of variation, field trials, diabetes duration, pharmacotherapy, glycemic control, cardiovascular risk stratification, risk prediction model
- MeSH terms
- Biological Variation, Individual, Aged, Australia, Blood Glucose, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Fasting, Female, Finland, Glycated Hemoglobin, Humans, Male, Middle Aged, New Zealand, Prospective Studies
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