This article was originally published here
Diabet Med. 2020 Nov 11:e14459. doi: 10.1111/dme.14459. Online ahead of print.
ABSTRACT
BACKGROUND: Clinical characteristics such as HbA1c , systolic blood pressure (SBP), albuminuria and estimated glomerular filtration rate (eGFR) are important when treating type 1 diabetes. We investigated the variability in these measures as risk markers for micro- and macrovascular complications.
METHODS: This prospective study included 1062 individuals with type 1 diabetes. Visit-to-visit variability of HbA1c , SBP, albuminuria, and eGFR was calculated as the SD of the residuals in individual linear regression models using all available measures in a specified period of 3 years (VV). Endpoints included: cardiovascular events (CVE) defined as myocardial infarction, non-fatal stroke, or coronary or peripheral arterial intervention; end-stage kidney disease (ESKD) defined as eGFR <15 ml/min/1.73m2 , chronic dialysis, or kidney transplantation; eGFR-decline ≥30%; and mortality. Adjustment included age, sex, cholesterol, HbA1c , SBP, body mass index, smoking, albuminuria, eGFR, and mean, intercept, slope of respective exposure variables and regression models.
RESULTS: SBP VV was significantly associated with CVE (adjusted hazard ratio per 50% increase, (CI 95%); p: 1.21 (1.05-1.39); p=0.008), ESKD (1.51 (1.16-1.96); p=0.002) and mortality (1.25 (1.09-1.44); p=0.002). HbA1c VV was significantly associated with mortality (1.51 (1.30-1.75); p<0.001); albuminuria VV with eGFR-decline (1.14 (1.08-1.20); p=0.024) and ESKD (1.14 (1.02-1.27); p<0.001), but neither CVE nor mortality. Adjusted eGFR VV was not associated with endpoints.
CONCLUSION: In type 1 diabetes, higher variability of basic clinical risk markers adds important risk stratification information for the development of micro- and macrovascular complications.
PMID:33179275 | DOI:10.1111/dme.14459
