Does glucose variability influence the relationship between mean plasma glucose and HbA 1c levels in type 1 and type 2 diabetic patients?

Judith C. Kuenen*, Rikke Borg, Dirk J. Kuik, Hui Zheng, David Schoenfeld, Michaela Diamant, David M. Nathan, Robert J. Heine

*Corresponding author af dette arbejde

    Publikation: Bidrag til tidsskriftArtikelForskningpeer review

    Abstract

    OBJECTIVE - The A1C-Derived Average Glucose (ADAG) study demonstrated a linear relationship between HbA 1c and mean plasma glucose (MPG). As glucose variability (GV) may contribute to glycation, we examined the association of several glucose variability indices and the MPG-HbA 1c relationship. RESEARCH DESIGN AND METHODS - Analyses included 268 patients with type 1 diabetes and 159 with type 2 diabetes. MPG during 3 months was calculated from 7-point self-monitored plasma glucose and continuous glucose monitoring. We calculated three different measures of GV and used a multiple-step regression model to determine the contribution of the respective GV measures to the MPG-HbA 1c relationship. RESULTS - GV, as reflected by SD and continuous overlapping net glycemic action, had a significant effect on the MPG-HbA 1c relationship in type 1 diabetic patients so that high GV led to a higher HbA 1c level for the same MPG. In type 1 diabetes, the impact of confounding and effect modification of a low versus high SD at an MPG level of 160 mg/dL on the HbA 1c level is 7.02 vs. 7.43 and 6.96 vs. 7.41. All GV measures showed the same tendency. CONCLUSIONS - In only type 1 diabetic patients, GV shows a significant interaction with MPG in the association with HbA 1c. This effect is more pronounced at higher HbA 1c levels. However, the impact of GV on the HbA 1c level in type 1 diabetes is modest, particularly when HbA 1c is close to the treatment target of 7%.

    OriginalsprogEngelsk
    Sider (fra-til)1843-1847
    Antal sider5
    TidsskriftDiabetes Care
    Vol/bind34
    Udgave nummer8
    DOI
    StatusUdgivet - 1 aug. 2011

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