Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis
Open accessAbstract
OBJECTIVE: Glycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA1c variability and micro- and macrovascular complications and mortality in type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: Medline and Embase were searched (2004–2015) for studies describing associations between HbA1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA1c variability, method of analysis, and diabetes type. RESULTS: Seven studies evaluated HbA1c variability among patients with type 1 diabetes and showed an association of HbA1c variability with renal disease (risk ratio 1.56 [95% CI 1.08–2.25], two studies), cardiovascular events (1.98 [1.39–2.82]), and retinopathy (2.11 [1.54–2.89]). Thirteen studies evaluated HbA1c variability among patients with type 2 diabetes. Higher HbA1c variability was associated with higher risk of renal disease (1.34 [1.15–1.57], two studies), macrovascular events (1.21 [1.06–1.38]), ulceration/gangrene (1.50 [1.06–2.12]), cardiovascular disease (1.27 [1.15–1.40]), and mortality (1.34 [1.18–1.53]). Most studies were retrospective with lack of adjustment for potential confounders, and inconsistency existed in the definition of HbA1c variability. CONCLUSIONS: HbA1c variability was positively associated with micro- and macrovascular complications and mortality independently of the HbA1c level and might play a future role in clinical risk assessment.
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Glycemic variability is associated with increased risk of cardiovascular disease in patients with type 2 diabetes.
“increased risk of cardiovascular disease18–20”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [20]
A meta-analysis by Gorst et al reported an association between HbA1c variability and microvascular and macrovascular complications and mortality.
“A meta-analysis by Gorst et al20 reported the association between HbA1c variability and microvascular and macrovascular complications and mortality.”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [20]
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- Authors
- Gorst, C., Kwok, C. S., Aslam, S., Buchan, I., Kontopantelis, E., Myint, P. K., Heatlie, G., Loke, Y., Rutter, M. K., & Mamas, M. A.
- Affiliations
- Institute of Population Health, Centre for Primary Care, University of Manchester, Manchester, U.K.
- University Hospitals of North Midlands NHS Trust (GB)
- Manchester Academic Health Science Centre (GB)
- University of Manchester (GB)
- University of Aberdeen (GB)
- University of East Anglia (GB)
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-11-19
- Volume
- 38
- Issue
- 12
- Pages
- 2354-2369
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2187025414
- Cited by
- 530
- References
- 52
- Citations by year
- 2026: 26 · 2025: 48 · 2024: 56 · 2023: 45 · 2022: 60 · 2021: 71 · 2020: 63 · 2019: 52 · 2018: 47 · 2017: 43 · 2016: 17
- FWCI
- 5.37
- Type
- journal article
- Language
- en
- Open access
- green
- ueaeprints.uea.ac.uk
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Keele Research Repository (Keele University) (submittedVersion, cc-by)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- National Institute for Health and Care Research (ACF-2013-06-001)
- Medical Research Council (MR/K006665/1, MC_PC_13042)
- Economic and Social Research Council (ES/J010014/1, ES/F029721/1)
- 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, HbA1c variability, type 1 diabetes, type 2 diabetes, microvascular complications, macrovascular complications, diabetic nephropathy, diabetic retinopathy, cardiovascular disease, mortality, diabetic foot ulcer, risk prediction
- MeSH terms
- Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Glycated Hemoglobin, Humans, Risk Factors
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