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Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial
Open accessAbstract
OBJECTIVE: There is uncertainty about the importance of glycemic variability in cardiovascular complications in patients with type 2 diabetes. Using the Veterans Affairs Diabetes Trial (VADT), we investigated the association between variation in fasting glucose and glycated hemoglobin (HbA1c) over time and the incidence of cardiovascular disease (CVD) and assessed whether this is influenced by intensive or standard glycemic control. RESEARCH DESIGN AND METHODS: During the VADT, fasting glucose and HbA1c were measured every 3 months for up to 84 months in 1,791 individuals. Variability measures included coefficient of variation (CV) and average real variability (ARV) for fasting glucose and HbA1c. Overall mean glucose and HbA1c measures as well as their maximum and the most recent measurement were also examined. RESULTS: Variability measures (CV and ARV) of fasting glucose were significantly associated with CVD even after adjusting for other risk factors, including mean fasting glucose. When considering separately groups receiving intensive and standard glycemic control, this relationship was evident in the intensive treatment group but not in the standard group. Additional adjustment for severe hypoglycemic episodes did not alter the relationship between fasting glucose variability and CVD. Interestingly, no HbA1c measures were associated with CVD after adjusting for multiple baseline risk factors. CONCLUSIONS: Our analysis indicates that in the VADT, variability of fasting glucose plays a role in the development of CVD complications beyond the influence of standard fasting glucose measures. The adverse consequences of fasting glucose variability on CVD appear greatest in those receiving intensive glucose control.
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“CV and ARV of FG were significantly associated with CVD: CV glucose: p=0.003, OR 1.162 (1.054–1.281); ARV glucose: p=0.0006, OR 1.168 (1.069–1.275).”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [51]
In the citing paper
“The results showed a significant association between variability of fasting glucose and cardiovascular disease even after adjusting for different risk factors, including mean fasting glucose.”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [51]
In the citing paper
“Conversely, the association was not present for HbA1c variability.”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [51]
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Self-citation
Metadata
- Authors
- Zhou, J. J., Schwenke, D. C., Bahn, G., & Reaven, P.
- Affiliations
- University of Arizona (US)
- Carl T. Hayden Veterans Affairs Medical Center (US)
- Edward Hines, Jr. VA Hospital (US)
- Corresponding author
- Zhou, Jin J.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2018-08-06
- Volume
- 41
- Issue
- 10
- Pages
- 2187-2194
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC6150432
- OpenAlex
- W2887193038
- Cited by
- 131
- References
- 37
- Citations by year
- 2026: 4 · 2025: 14 · 2024: 9 · 2023: 24 · 2022: 16 · 2021: 23 · 2020: 24 · 2019: 17
- FWCI
- 12.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (R01-067690, 5R01-094775, K01-DK-106116)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- glycemic variability, cardiovascular disease, type 2 diabetes, fasting blood glucose, HbA1c, tight glycemic control, coefficient of variation, average real variability, hypoglycemia
- MeSH terms
- Aged, Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Fasting, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Risk Factors, Veterans
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