Recent studies have shown that long-term and short-term glycemic variability (measured by low concentrations of the biomarker 1,5-anhydroglucitol (1,5-AG)) were associated with incident diabetes complications; yet, none have assessed their relative importance. Using the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, we measured 1,5-AG 12 months from randomization (when HbA1c was stable) in 4,000 randomly selected samples and assessed the risk of short-term and long-term glycemic variability for incident renal complications. The coefficient of variation of fasting glucose (CV-FG) was used to measure long-term variability. Primary outcomes were time (after 12 months) to 1) microalbuminuria and 2) macroalbuminuria. Risks were estimated using Cox proportional hazard models. Both CV-FG and lower 1,5-AG were independently associated with microalbuminuria even after adjusting for other risk factors (Table). Only CV-FG was a significant risk factor for macroalbuminuria. After adjusting for average glycemic control, the CV-FG association remained. Subgroup analysis indicated that CV-FG and 1,5 AG were more harmful in those receiving less intensive glucose control. The secondary outcome analysis supported the main conclusion (Table). This post hoc analysis indicates that long-term and short-term glucose variability may play a role in developing renal diseases in T2D.
T.Okuno: None. P.Reaven: Research Support; Dexcom, Inc. J.Zhou: None.
National Institutes of Health (R01HG006139, DMS-2054253, IIS-2205441, R21HL150374)
