Ac variability causes -
However, mean HbA 1c just reflects average glycemia derived without regard to glycemic variability, which is associated with higher risk of hypoglycemia on average Visit-to-visit glycemic variability might be an important confounder for glycemia control and long-term prognosis and should be considered in the management of diabetes.
Our study should be interpreted within the context of its strengths and limitations. The strengths of our study include a large number of high-risk patients and a large number of HbA 1c measures, which enable us to accurately calculate HbA 1c variability.
We used three variability indices, which enable us to study HbA 1c variability more comprehensively. The variability index, VIM, can diminish the tight correlation between the CV and mean and was more suitable for the mean and variability cross-tabulation analysis.
The analyses also have limitations. The ACCORD study used HbA 1c rather than glucose as the target and evaluation indices, and glucose was not recorded at every visit, so in this study we only focus on HbA 1c. Because of the post hoc nature of the analysis and the highly selected study population, which included patients at high risk of CVD, the results should be extended to real-world studies including patients with type 2 diabetes having a variety of risk characteristics.
Our study confirmed that long-term visit-to-visit variability in HbA 1c was a strong predictor of a variety of all-cause mortality.
HbA 1c variability combined with HbA 1c mean conferred an increased risk for all-cause mortality in the intensive-therapy group in the ACCORD trial. See accompanying article, p.
The investigators acknowledge and thank the ACCORD investigators and the National Heart, Lung, and Blood Institute for conducting the trials and making data sets publicly available. Special thanks to Yonghua Xu and Min Hang Shanghai Jiaotong University for their data sets preparation.
Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. and J. contributed to the statistical analysis and wrote the manuscript.
participated in acquisition, analysis, or interpretation of data. reviewed and edited the manuscript. All authors participated in critical revision of the manuscript for important intellectual content.
is the guarantor of the work and as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Sign In or Create an Account.
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Research Design and Methods. Article Information. Article Navigation. Prognostic Significance of Long-term HbA 1c Variability for All-Cause Mortality in the ACCORD Trial Chang-Sheng Sheng ; Chang-Sheng Sheng. This Site. Google Scholar.
Jingyan Tian Jingyan Tian. Corresponding authors: Guang Ning, gning sibs. cn , and Jingyan Tian, tianjypaper Ya Miao ; Ya Miao. Yi Cheng ; Yi Cheng. Yulin Yang ; Yulin Yang.
Peter D. Reaven ; Peter D. Hayden Veterans Affairs Medical Center, Phoenix, AZ. Zachary T. Bloomgarden Guang Ning Guang Ning. Diabetes Care ;43 6 — Article history Received:. Connected Content. A commentary has been published: Glucose Variability and Diabetic Complications: Is It Time to Treat? Get Permissions.
toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Table 1 Characteristics of the patients at baseline or during follow-up.
All patients. Therapy status. HbA 1c variability. View Large. Table 2 Association of mean and variability indexes of HbA 1c from the 8th month to the transition during follow-up with all-cause mortality. Adjusted model. Table 3 Cross-tabulation of HbA 1c mean and variability tertiles in relation to all-cause mortality.
Intensive therapy. Standard therapy. T2 of mean 6. T2 of mean 7. Figure 1. View large Download slide. contributed equally to this work. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes UKPDS 35 : prospective observational study.
Search ADS. Life expectancy and cause-specific mortality in type 2 diabetes: a population-based cohort study quantifying relationships in ethnic subgroups. Effects of high blood pressure on cardiovascular disease events among Chinese adults with different glucose metabolism.
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Glucose control and vascular complications in veterans with type 2 diabetes. Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials.
Visit-to-visit HbA1c and glucose variability and the risks of macrovascular and microvascular events in the general population. Association between HbA1c variability and mortality in patients with type 2 diabetes.
Risk association of HbA1c variability with chronic kidney disease and cardiovascular disease in type 2 diabetes: prospective analysis of the Hong Kong Diabetes Registry. HbA1c variability as an independent correlate of nephropathy, but not retinopathy, in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events RIACE Italian multicenter study.
Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study. Variability in glycated hemoglobin and risk of poor outcomes among people with type 2 diabetes in a large primary care cohort study.
Visit-to-visit glycemic variability and risks of cardiovascular events and all-cause mortality: the ALLHAT study. Long-term effects of intensive glucose lowering on cardiovascular outcomes. Action to Control Cardiovascular Risk in Diabetes ACCORD trial: design and methods.
Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes ACCORD trial. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension.
A reliable index for the prognostic significance of blood pressure variability. Intrapersonal HbA 1c variability and the risk of progression of nephropathy in patients with type 2 diabetes.
Risks of diabetic nephropathy with variation in hemoglobin A1c and fasting plasma glucose. Variability in hemoglobin A1c predicts all-cause mortality in patients with type 2 diabetes.
Long-term glycemic variability and risk of adverse outcomes: a systematic review and meta-analysis. Glycemic variation and cardiovascular risk in the Veterans Affairs Diabetes Trial.
Impact of visit-to-visit glycemic variability on the risks of macrovascular and microvascular events and all-cause mortality in type 2 diabetes: the ADVANCE trial.
Prognostic impact of visit-to-visit glycemic variability on the risks of major adverse cardiovascular outcomes and hypoglycemia in patients with different glycemic control and type 2 diabetes. Glycaemic variation is a predictor of all-cause mortality in the Veteran Affairs Diabetes Trial.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Supplementary data Supplementary Tables and Figure - pdf file. View Metrics. Email alerts Article Activity Alert. No potential conflicts of interest relevant to this article were reported.
Author Contributions. searched databases, selected studies, extracted data, and wrote the manuscript. searched databases, selected studies, extracted and analyzed data, and contributed to writing the manuscript. selected studies and extracted data. contributed to the discussion. and M.
selected studies, contributed to the discussion, and reviewed and edited the manuscript. and G. reviewed and edited the manuscript. extracted and analyzed data, contributed to the discussion, and reviewed and edited the manuscript. contributed to the design and reviewed and edited the manuscript.
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Meta-analysis November 19 Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis Catherine Gorst ; Catherine Gorst. Corresponding author: Catherine Gorst, catherine. gorst postgrad. This Site. Google Scholar. Chun Shing Kwok ; Chun Shing Kwok. Saadia Aslam ; Saadia Aslam.
Iain Buchan ; Iain Buchan. Evangelos Kontopantelis ; Evangelos Kontopantelis. Phyo K. Myint ; Phyo K. Grant Heatlie ; Grant Heatlie. Yoon Loke ; Yoon Loke. Martin K. Rutter ; Martin K. Mamas A. Mamas Mamas A. Diabetes Care ;38 12 — Article history Received:. Get Permissions.
toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Figure 1. View large Download slide. Table 1 Design and participant characteristics of studies that evaluated glycemic variability.
Study ID. Study design; year; country. Sample size. Inclusion criteria. View Large. Table 2 Risk of bias among studies that evaluated glycemic variability and adverse outcomes.
Time frame and number of samples used to define HbA 1c variability. Case definition, ascertainment, and assessment frequency. Adjustments for potential confounders. Table 3 Results of studies that evaluated glycemic variability and adverse outcomes. Definition of glycemic variability.
Outcomes evaluated. Study follow-up. fourth quartile HR 1. no retinopathy: OR 0. UK Prospective Diabetes Study UKPDDS Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS Lancet ;— Search ADS.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. The relationship of glycemic exposure HbA 1c to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial.
A1C variability and the risk of microvascular complications in type 1 diabetes: data from the Diabetes Control and Complications Trial. Glycemic variability: a hemoglobin A1c-independent risk factor for diabetic complications.
Do data in the literature indicate that glycaemic variability is a clinical problem? Glycaemic variability and vascular complications of diabetes. HbA1C variability and the risk of renal status progression in diabetes mellitus: a meta-analysis. A1C variability predicts incident cardiovascular events, microalbuminuria, and overt diabetic nephropathy in patients with type 1 diabetes.
HbA1c variability is associated with an increased risk of retinopathy requiring laser treatment in type 1 diabetes. Risk association of HbA1c variability with chronic kidney disease and cardiovascular disease in type 2 diabetes: prospective analysis of the Hong Kong Diabetes Registry.
Association between HbA1c variability and mortality in patients with type 2 diabetes. Variability in hemoglobin A1c predicts all-cause mortality in patients with type 2 diabetes.
HbA1c variability as an independent correlate of nephropathy, but not retinopathy, in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events RIACE Italian Multicenter Study. Hemoglobin A1c variability as an independent correlate of cardiovascular disease in patients with type 2 diabetes: a cross-sectional analysis of the Renal Insufficiency And Cardiovascular Events RIACE Italian Multicenter Study.
Impact of visit-to-visit glycemic variability on the risks of macrovascular and microvascular events and all-cause mortality in type 2 diabetes: the ADVANCE trial.
Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study. Assessment of the association between glycemic variability and diabetes-related complications in type 1 and type 2 diabetes.
Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature. Glycemic control patterns and kidney disease progression among primary care patients with diabetes mellitus. HbA1c variability is associated with microalbuminuria development in type 2 diabetes: a 7-year prospective cohort study.
A1C variability predicts the risk of microalbuminuria among children with type 1 diabetes mellitus T1DM. Presented at the 71st Scientific Sessions of the American Diabetes Association, June , San Diego, CA. Intrapersonal HbA 1c variability and the risk of progression of nephropathy in patients with type 2 diabetes.
HbA 1c variability and the development of microalbuminuria in type 2 diabetes: Tsukuba Kawai Diabetes Registry 2. Risks of diabetic nephropathy with variation in hemoglobin A1c and fasting plasma glucose. A1C variability as an independent risk factor for microalbuminuria in young people with type 1 diabetes.
Department of Health. National Service Framework for Diabetes. London, Department of Health, Health and Social Care Information Centre. Quality and outcomes framework, Accessed 27 May Loke YK, Price D, Herxheimer A.
Adverse effects. In Cochrane Handbook for Systematic Reviews of Interventions. Higgins JPT, Green S, Eds. Chichester, U. The appropriateness of asymmetry tests for publication bias in meta-analyses: a large survey.
Metabolic control and its variability are major risk factors for microalbuminuria in children with type 1 diabetes. Effect of glycaemic control on outcome in patients with type 2 diabetes mellitus and chronic heart failure. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes.
Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Acute and chronic fluctuations in blood glucose levels can increase oxidative stress in type 2 diabetes mellitus.
Intermittent high glucose enhances ICAM-1, VCAM-1 and E-selectin expression in human umbilical vein endothelial cells in culture: the distinct role of protein kinase C and mitochondrial superoxide production.
Normalizing mitochondrial superoxide production blocks three pathways of hyperglycaemic damage. Glucose oscillations, more than constant high glucose, induce p53 activation and a metabolic memory in human endothelial cells. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy.
Mechanisms of disease: pathway-selective insulin resistance and microvascular complications of diabetes. Comparing mortality and time until death for Medicare HMO and FFS beneficiaries.
Psychological distress, glycated hemoglobin, and mortality in adults with and without diabetes. A re-analysis of the Cochrane Library data: the dangers of unobserved heterogeneity in meta-analyses. Performance of statistical methods for meta-analysis when true study effects are non-normally distributed: a simulation study.
Quantifying the longitudinal value of healthcare record collections for pharmacoepidemiology. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. Supplementary data Supplementary Data - pdf file.
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Hermann Hietala Kilpatrick 6. Marcovecchio Nazim Raman Wadén Lin Cummings Foo Hirakawa Hsu Participants with type 2 diabetes enrolled in the Diabetes Management Through an Integrated Delivery System project. Lang Luk Participants in the Hong Kong Diabetes Registry Patients with baseline CKD were excluded in the analysis of the renal end point, and patients with baseline CVD were excluded in the analysis of cardiovascular end points.
Ma Participants in the Diabetes Shared Care Program at the Cardinal Tien Hospital and attending clinic approximately every 3 months. Penno 16 , Rodríguez-Segade Participants with diabetes attending outpatient clinics of the University Hospital Complex of Santiago de Compostela.
Skriver Participants with type 2 diabetes with registered public data files in Aarhus County, Denmark, who subsequently had at least three HbA 1c measurements. Sugawara Takao Participants with type 2 diabetes attending an outpatient clinic and followed up for 2 years with at least four HbA 1c levels.
Between and March Median number of HbA 1c values per patient during 1 year: 4. Renal status, diabetes duration, mean HbA 1c , blood pressure, sex, and number of HbA 1c measurements. Average follow-up: 6. Age, sex, disease duration, randomization treatment, prevention cohort, and baseline HbA 1c.
Between and and between and Median number of HbA 1c assessments: 4 2— Microalbuminuria was defined as ACR 3. Age at onset of diabetes, presence of arterial hypertension at baseline, mean HbA 1c , and mean insulin daily dose. Median follow-up: 5. Renal status prospectively assessed by review of all recorded values of urine AER and medical records Progression of renal disease defined as a shift to a higher albuminuria level in any two of three consecutive urine collections or end-stage renal failure Cardiovascular events myocardial infarction, coronary artery procedure, stroke, limb amputation due to ischemia, peripheral artery procedure based on medical records at baseline and follow-up Frequency of evaluation unclear.
Duration of diabetes, sex, blood pressure, total cholesterol, smoking, intrapersonal mean of serial HbA 1c measurements, number of HbA 1c measurements, diabetic nephropathy, and baseline cardiovascular events.
Average follow-up: 4. Age, sex, lifestyle factors, comorbidities, myocardial infarction, mean fasting plasma glucose, mean HbA 1c , and drug treatments.
Age, race, sex, duration of diabetes, blood pressure, drug treatments, initial HbA 1c and number of HbA 1c values, and fasting blood glucose CV. Age, sex, ethnicity, duration of diabetes, hypertension, hyperlipidemia, smoking, microalbuminuria and cardiovascular events, and mean and SD of HbA 1c.
The Diabetic foot complications is now 1. But baked into that seemingly Organic caffeine source change in the average is a big cauuses Building lean muscle dangerous extreme temperatures. The Ac variability causes of extreme variabillity is playing out vadiability now in several places around the world. A gargantuan heat wave over India and Pakistanwhere 1. The heat has triggered power outages, created water shortages, and killed dozens, although the true toll may not be known for weeks. Swaths of western Europe are also facing a heat wavewith temperatures forecasted to breach 40°C, or °F, later this week.Video
Difference between AC and DC Current Explained - AddOhms #5 Cardiovascular Overcoming cravings through self-awareness volume Diabetic foot complicationsArticle number: Cite varisbility article. Variabiluty details. Acc Diabetic foot complications regarding long-term glucose variability over several years which is an emerging indicator of glycemic Varability in diabetes showed several limitations. We investigated whether variability variabiliry long-term fasting plasma glucose FG can predict the development of stroke, myocardial infarction MIand all-cause mortality in patients with diabetes. This is a retrospective cohort study using the data provided by the Korean National Health Insurance Corporation. As a parameter of variability of FG, variability independent of mean VIM was calculated using FG levels measured at least three times during the 5 years until the baseline. Study endpoints were incident stroke, MI, and all-cause mortality through December 31,
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