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Intrapersonal HbA 1c variability and the risk of progression of nephropathy in patients with Type 2 diabetes
Author(s) -
RodríguezSegade S.,
Rodríguez J.,
García López J. M.,
Casanueva F. F.,
Camiña F.
Publication year - 2012
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2012.03767.x
Subject(s) - medicine , nephropathy , diabetes mellitus , hazard ratio , retinopathy , endocrinology , proportional hazards model , type 2 diabetes , diabetic nephropathy , confidence interval
Diabet. Med. 29, 1562–1566 (2012) Abstract Aim To investigate the association between nephropathy and HbA 1c variability (assessed as the standard deviation of each patient’s HbA 1c measurements) among patients with Type 2 diabetes. Methods Albumin excretion rate and HbA 1c were measured in 2103 patients followed up for a mean 6.6 years. Multivariate Cox regression analysis was used to determine the influence of HbA 1c variability on the risk of progression of nephropathy after adjustment for age, sex, duration of diabetes, baseline condition (two cohorts defined by duration of diabetes, retinopathy and albumin excretion rate), baseline HbA 1c , insulin use, BMI, use of anti‐hypertensive agents, smoking, lipid status, retinopathy, updated mean HbA 1c and number of HbA 1c measurements. Results Nephropathy progressed in 18.3% of subjects. HbA 1c variability was significantly greater among progressors than among non‐progressors (12 vs. 10 mmol/mol; 1.12 vs. 0.90%; P < 0.0001) and was a significant predictor of progression of nephropathy even after adjustment for updated mean HbA 1c and other risk factors (hazard ratio 1.37, 95% CI 1.12–1.69). Conclusion In patients with Type 2 diabetes, the risk of progression of nephropathy increases significantly with HbA 1c variability, independently of the influence of updated mean HbA 1c .