Association of Glycemic Variability in Type 1 Diabetes With Progression of Microvascular Outcomes in the Diabetes Control and Complications Trial.
Association of Glycemic Variability in Type 1 Diabetes With Progression of Microvascular Outcomes in the Diabetes Control and Complications Trial.
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DOI：
10.2337/dc16-2426
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发表时间：
2017-06
期刊：
影响因子：
16.2
通讯作者：
DCCT/EDIC Research Group
中科院分区：
文献类型：
--
作者：
Lachin JM;Bebu I;Bergenstal RM;Pop-Busui R;Service FJ;Zinman B;Nathan DM;DCCT/EDIC Research Group
糖尿病控制和并发症试验 (DCCT) 证明了强化治疗与常规治疗相比，对 1 型糖尿病微血管并发症的发生和进展具有有益效果。这些有益效果几乎完全可以用各组之间 HbA1c 水平的差异来解释，而 HbA1c 水平又与这些并发症的风险相关。我们评估了 DCCT 期间每季度 7 点血糖曲线内和之间的血糖变异性与视网膜病变、肾病和心血管自主神经病变的发生和进展之间的关联。变异性测量包括 SD 的日内和更新平均值（随时间变化）、血糖波动平均幅度 (MAGE) 和 M 值，以及日内纵向、日间和总方差。插补方法填补了 16.3% 缺失的预期葡萄糖值。 Cox比例风险模型评估了血糖变化的每项测量值（作为时间依赖性协变量）与视网膜病变和肾病风险的关联，纵向逻辑回归模型对心血管自主神经病变也进行了同样的评估。根据平均血糖进行调整后，日内变异性的测量与任何结果均无关。当根据纵向平均血糖进行调整并使用 Holm 程序校正多次测试时，只有纵向平均 M 值（随时间变化）与微量白蛋白尿显着相关。总体而言，根据季度血糖曲线确定的日内血糖变异性，除了平均血糖的影响外，在微血管并发症的发生中并没有发挥明显的作用。
The Diabetes Control and Complications Trial (DCCT) demonstrated the beneficial effects of intensive versus conventional therapy on the development and progression of microvascular complications of type 1 diabetes. These beneficial effects were almost completely explained by the difference between groups in the levels of HbA1c, which in turn were associated with the risk of these complications. We assessed the association of glucose variability within and between quarterly 7-point glucose profiles with the development and progression of retinopathy, nephropathy, and cardiovascular autonomic neuropathy during the DCCT. Measures of variability included the within-day and updated mean (over time) of the SD, mean amplitude of glycemic excursions (MAGE), and M-value, and the longitudinal within-day, between-day, and total variances. Imputation methods filled in the 16.3% of expected glucose values that were missing. Cox proportional hazards models assessed the association of each measure of glycemic variation, as a time-dependent covariate, with the risk of retinopathy and nephropathy, and a longitudinal logistic regression model did likewise for cardiovascular autonomic neuropathy. Adjusted for mean blood glucose, no measure of within-day variability was associated with any outcome. Only the longitudinal mean M-value (over time) was significantly associated with microalbuminuria when adjusted for the longitudinal mean blood glucose and corrected for multiple tests using the Holm procedure. Overall, within-day glycemic variability, as determined from quarterly glucose profiles, does not play an apparent role in the development of microvascular complications beyond the influence of the mean glucose.