Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis

Catherine Gorst, Chun Shing Kwok, Saadia Aslam, Iain Buchan, Evangelos Kontopantelis, Phyo K Myint, Grant Heatlie, Yoon Loke, Martin K Rutter, Mamas A Mamas

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Abstract

OBJECTIVE: Glycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA1c variability and micro- and macrovascular complications and mortality in type 1 and type 2 diabetes.

RESEARCH DESIGN AND METHODS: Medline and Embase were searched (2004-2015) for studies describing associations between HbA1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA1c variability, method of analysis, and diabetes type.

RESULTS: Seven studies evaluated HbA1c variability among patients with type 1 diabetes and showed an association of HbA1c variability with renal disease (risk ratio 1.56 [95% CI 1.08-2.25], two studies), cardiovascular events (1.98 [1.39-2.82]), and retinopathy (2.11 [1.54-2.89]). Thirteen studies evaluated HbA1c variability among patients with type 2 diabetes. Higher HbA1c variability was associated with higher risk of renal disease (1.34 [1.15-1.57], two studies), macrovascular events (1.21 [1.06-1.38]), ulceration/gangrene (1.50 [1.06-2.12]), cardiovascular disease (1.27 [1.15-1.40]), and mortality (1.34 [1.18-1.53]). Most studies were retrospective with lack of adjustment for potential confounders, and inconsistency existed in the definition of HbA1c variability.

CONCLUSIONS: HbA1c variability was positively associated with micro- and macrovascular complications and mortality independently of the HbA1c level and might play a future role in clinical risk assessment.

Original languageEnglish
Pages (from-to)2354-2369
Number of pages16
JournalDiabetes Care
Volume38
Issue number12
Early online date24 Nov 2015
DOIs
Publication statusPublished - 1 Dec 2015

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Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Meta-Analysis
Mortality
Kidney
Gangrene
Cardiovascular Diseases
Retrospective Studies
Odds Ratio

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Gorst, C., Kwok, C. S., Aslam, S., Buchan, I., Kontopantelis, E., Myint, P. K., ... Mamas, M. A. (2015). Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis. Diabetes Care, 38(12), 2354-2369. https://doi.org/10.2337/dc15-1188

Long-term Glycemic Variability and Risk of Adverse Outcomes : A Systematic Review and Meta-analysis. / Gorst, Catherine; Kwok, Chun Shing; Aslam, Saadia; Buchan, Iain; Kontopantelis, Evangelos; Myint, Phyo K; Heatlie, Grant; Loke, Yoon; Rutter, Martin K; Mamas, Mamas A.

In: Diabetes Care, Vol. 38, No. 12, 01.12.2015, p. 2354-2369.

Research output: Contribution to journalArticle

Gorst, C, Kwok, CS, Aslam, S, Buchan, I, Kontopantelis, E, Myint, PK, Heatlie, G, Loke, Y, Rutter, MK & Mamas, MA 2015, 'Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis', Diabetes Care, vol. 38, no. 12, pp. 2354-2369. https://doi.org/10.2337/dc15-1188
Gorst, Catherine ; Kwok, Chun Shing ; Aslam, Saadia ; Buchan, Iain ; Kontopantelis, Evangelos ; Myint, Phyo K ; Heatlie, Grant ; Loke, Yoon ; Rutter, Martin K ; Mamas, Mamas A. / Long-term Glycemic Variability and Risk of Adverse Outcomes : A Systematic Review and Meta-analysis. In: Diabetes Care. 2015 ; Vol. 38, No. 12. pp. 2354-2369.
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T2 - A Systematic Review and Meta-analysis

AU - Gorst, Catherine

AU - Kwok, Chun Shing

AU - Aslam, Saadia

AU - Buchan, Iain

AU - Kontopantelis, Evangelos

AU - Myint, Phyo K

AU - Heatlie, Grant

AU - Loke, Yoon

AU - Rutter, Martin K

AU - Mamas, Mamas A

N1 - © 2015 by the American Diabetes Association. 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.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - OBJECTIVE: Glycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA1c variability and micro- and macrovascular complications and mortality in type 1 and type 2 diabetes.RESEARCH DESIGN AND METHODS: Medline and Embase were searched (2004-2015) for studies describing associations between HbA1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA1c variability, method of analysis, and diabetes type.RESULTS: Seven studies evaluated HbA1c variability among patients with type 1 diabetes and showed an association of HbA1c variability with renal disease (risk ratio 1.56 [95% CI 1.08-2.25], two studies), cardiovascular events (1.98 [1.39-2.82]), and retinopathy (2.11 [1.54-2.89]). Thirteen studies evaluated HbA1c variability among patients with type 2 diabetes. Higher HbA1c variability was associated with higher risk of renal disease (1.34 [1.15-1.57], two studies), macrovascular events (1.21 [1.06-1.38]), ulceration/gangrene (1.50 [1.06-2.12]), cardiovascular disease (1.27 [1.15-1.40]), and mortality (1.34 [1.18-1.53]). Most studies were retrospective with lack of adjustment for potential confounders, and inconsistency existed in the definition of HbA1c variability.CONCLUSIONS: HbA1c variability was positively associated with micro- and macrovascular complications and mortality independently of the HbA1c level and might play a future role in clinical risk assessment.

AB - OBJECTIVE: Glycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA1c variability and micro- and macrovascular complications and mortality in type 1 and type 2 diabetes.RESEARCH DESIGN AND METHODS: Medline and Embase were searched (2004-2015) for studies describing associations between HbA1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA1c variability, method of analysis, and diabetes type.RESULTS: Seven studies evaluated HbA1c variability among patients with type 1 diabetes and showed an association of HbA1c variability with renal disease (risk ratio 1.56 [95% CI 1.08-2.25], two studies), cardiovascular events (1.98 [1.39-2.82]), and retinopathy (2.11 [1.54-2.89]). Thirteen studies evaluated HbA1c variability among patients with type 2 diabetes. Higher HbA1c variability was associated with higher risk of renal disease (1.34 [1.15-1.57], two studies), macrovascular events (1.21 [1.06-1.38]), ulceration/gangrene (1.50 [1.06-2.12]), cardiovascular disease (1.27 [1.15-1.40]), and mortality (1.34 [1.18-1.53]). Most studies were retrospective with lack of adjustment for potential confounders, and inconsistency existed in the definition of HbA1c variability.CONCLUSIONS: HbA1c variability was positively associated with micro- and macrovascular complications and mortality independently of the HbA1c level and might play a future role in clinical risk assessment.

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DO - 10.2337/dc15-1188

M3 - Article

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VL - 38

SP - 2354

EP - 2369

JO - Diabetes Care

JF - Diabetes Care

SN - 0149-5992

IS - 12

ER -