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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Gorst, C., Kwok, C. S., Aslam, S., Buchan, I., Kontopantelis, E., Myint, P. K., Heatlie, G., Loke, Y., Rutter, M. 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