Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1 diabetes
Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1 diabetes
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DOI：
10.2337/diacare.27.6.1259
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发表时间：
2004-06-01
期刊：
影响因子：
16.2
通讯作者：
Chalew, SA
中科院分区：
文献类型：
--
作者：
McCarter, RJ;Gomez, R;Chalew, SA
目的-我们假设HbA（1c）的生物学变异与平均血糖（MBG）的变异不同，将预测糖尿病控制和并发症试验（DCCT.RESEARCH DESIGN AND METHODS）中微血管并发症的风险。计算每次访视的血红蛋白糖化指数（HGI =观察到的HbA（1c）-预测的HbA（1c）），以基于观察到的HbA（1c）与模型中MBG预测值的方向偏差评估生物学变异。根据研究期间参与者的平均HGI，将人群细分为高、中、低HGI组。考克斯比例风险分析比较的风险发展或进展的视网膜病变和肾病之间的HGI组控制MBG，年龄，治疗组，分层，和duration of diabetes.RESULTS-Likewise比和t检验HGI拒绝的假设，即HbA（1c）水平是由MBG单独决定的。在7年的随访中，高HGI组的患者（高于预测的HbA（1c））的视网膜病变风险高3倍（30 vs. P < 0.001），肾病风险增加6倍（6vs.1%，P < 0.001）与低HGI组相比。结论-HbA（1c）的个体间生物学变异与MBG不同，在DCCT中的7型糖尿病患者中是明显的，并且是糖尿病并发症风险的强预测因子。确定负责HbA（1c）生物学变异的过程可能会导致新的治疗方法，以增加针对降低血糖水平和预防糖尿病并发症的治疗。
OBJECTIVE- We hypothesized that biological variation in HbA(1c) distinct from variation attributable to mean blood glucose (MBG), would predict risk for microvascular complications in the Diabetes Control and Complications Trial (DCCT).RESEARCH DESIGN AND METHODS- A longitudinal multiple regression model was developed from MBG and HbA(1c) measured in the 1,447 DCCT participants at quarterly visits. A hemoglobin glycation index (HGI = observed HbA(1c)-predicted HbA(1c)) was calculated for each visit to assess biological variation based on the directional deviation of observed HbA(1c) from that predicted by MBG in the model. The population was subdivided by thirds into high-, moderate-, and low-HGI groups based on mean participant HGI during the study. Cox proportional hazard analysis compared risk for development or progression of retinopathy and nephropathy between HGI groups controlled for MBG, age, treatment group, strata, and duration of diabetes.RESULTS- Likelihood ratio and t tests on HGI rejected the assumption that HbA(1c) levels were determined by MBG alone. At 7 years' follow-up, patients in the high-HGI group (higher-than-predicted HbA(1c)) had three times greater risk of retinopathy (30 vs. P < 0.001) and six times greater risk of nephropathy (6 vs. 1%, P < 0.001) compared with the low-HGI group.CONCLUSIONS- Between-individual biological variation in HbA(1c) which is distinct from that attributable to MBG, was evident among type 7 diabetic patients in the DCCT and was a strong predictor of risk for diabetes complications. Identification of the processes responsible for biological variation in HbA(1c) could lead to novel therapies to augment treatments directed at lowering blood glucose levels and preventing diabetes complications.