Can glycaemic variability, as calculated from blood glucose self-monitoring, predict the development of complications in type 1 diabetes over a decade?

Diabetes Metab. 2008 Dec;34(6 Pt 1):612-6. doi: 10.1016/j.diabet.2008.04.005. Epub 2008 Sep 27.

Abstract

Aims: Is glycaemic variability an independent risk factor for the development of microvascular complications in addition to average glycaemia, as assessed by glycated haemoglobin (HbA(1c))? In this study, an 11-year follow-up was carried out in patients with type 1 diabetes. The standard deviation of blood glucose (SDBG) concentration, an index of glycaemic variability, was calculated from self-monitored blood glucose data at baseline.

Methods: A total of 100 patients were randomly selected from 442 consecutive type 1 diabetic patients attending our outpatients clinic. SDBG was calculated from 70 measurements taken over a period of four weeks. Onset and progression of micro- and macrovascular complications were recorded over the 11-year follow-up.

Results: As expected, the prevalence of complications increased over time. Statistical analyses showed that HbA(1c) was an independent predictor of the incidence (P=0.004) and prevalence (P=0.01) of nephropathy. SDBG was found to be a predictor of the prevalence of peripheral neuropathy (P=0.03), and showed borderline significance in predicting the incidence of peripheral neuropathy (P=0.07). SDBG was also a highly significant predictor of hypoglycaemic unawareness (P=0.001).

Conclusions: We conclude that variability of blood glucose may be important in the development of peripheral neuropathy in patients with type 1 diabetes, and that the nervous system may be particularly vulnerable to glycaemic variability.

MeSH terms

  • Adult
  • Awareness
  • Blood Glucose / metabolism*
  • Blood Glucose Self-Monitoring / methods*
  • Body Mass Index
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetic Angiopathies / blood
  • Diabetic Angiopathies / epidemiology*
  • Diabetic Nephropathies / blood
  • Diabetic Nephropathies / epidemiology
  • Diabetic Neuropathies / blood
  • Diabetic Neuropathies / epidemiology
  • Diabetic Retinopathy / blood
  • Diabetic Retinopathy / epidemiology
  • Female
  • Glycated Hemoglobin A / analysis*
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Predictive Value of Tests
  • Prevalence

Substances

  • Blood Glucose
  • Glycated Hemoglobin A