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Aims/Introduction  The relationship between glycemic variability ( GV ) and diabetic complications has gained much interest and remains under debate. Furthermore, the association of  GV  with diabetic complications has not been examined in latent autoimmune diabetes of the adult ( LADA ). Therefore, we evaluated the relationships among several metrics of  GV  with diabetic retinopathy ( DR ) in patients with  LADA  and type 2 diabetes mellitus.    Materials and Methods  A total of 192 patients with  LADA  and 2,927 patients with type 2 diabetes mellitus were enrolled. After continuous glucose monitoring for 72 h, three metrics of  GV  including standard deviation, coefficient of variation and mean amplitude of glycemic excursions were calculated.  DR  was assessed by fundus photography performed with a digital non‐mydriatic camera.    Results  The prevalence of  DR  was 20.3 and 26.4% in  LADA  and type 2 diabetes mellitus patients ( P  <   0.001), respectively. Generally,  LADA  patients had fewer cardiometabolic risk factors than type 2 diabetes mellitus patients, and all  GV  metrics were significantly higher in  LADA  than in type 2 diabetes mellitus. In the multivariate logistic regression analysis, no metrics for  GV  were identified as independent risk factors of  DR  (standard deviation:  P =  0.175; coefficient of variation:  P =  0.769; mean amplitude of glycemic excursions:  P =  0.388) in  LADA . However, the standard deviation was significantly associated with  DR  ( OR  1.15,  P =  0.017) in patients with type 2 diabetes mellitus after adjusting for confounders. The independent relationships of coefficient of variation and mean amplitude of glycemic excursions with  DR  ( P =  0.194 and  P =  0.251, respectively) did not reach statistical significance in type 2 diabetes mellitus.    Conclusions   GV  is more strongly associated with  DR  in type 2 diabetes than in  LADA , suggesting that different glucose‐lowering strategies should be used for these two types of diabetes.

journal of diabetes investigation

Glycemic variability assessed by continuous glucose monitoring and the risk of diabetic retinopathy in latent autoimmune diabetes of the adult and type 2 diabetes