Extent of Blood Sugar Variability 1 Year After Diagnosis Of
A retrospective cohort analysis from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database—a large, English primary care network—was conducted. We followed newly diagnosed patients with type 2 diabetes, on or after 1 January 2005, aged 25 years or older at diagnosis, with HbA1c measurements at both diagnosis and after 1 year, plus five or more measurements of HbA1c thereafter. Three glycemic bands were created: groups A (HbA1c<58 mmol/mol [<7.5%]), B (HbA1c 58 to 75 mmol/mol [7.5%-9.0%]) and C (HbA1c 75 mmol/mol [9.0%]). Movement between bands was determined from diagnosis to 1 year. Additionally, for data after the first 12 months, a glycemic variability score was calculated from the number of successive HbA1c readings differing by 0.5% or higher (5.5mmol/mol). Risk of MACE from 1 year postdiagnosis was assessed using time-varying Cox proportional hazards models, which included the first-year transition and the glycemic variability score.

From 26,180 patients, there were 2300 MACE. Compared with group A->A transition over 1 year, those with C->A transition had a reduced risk of MACE (HR 0.75; 95% CI 0.60-0.94; P =.014), whereas group C->C had HR 1.21 (0.81-1.81; P =.34). Compared with the lowest glycemic variability score, the greatest variability increased the risk of MACE (HR 1.51; 1.11-2.06; P =.0096).

Early control of HbA1c improved cardiovascular outcomes in type 2 diabetes, although subsequent glycemic variability had a negative effect on an individual's risk.

Source: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14705
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