Variable A1C Linked to Renal Disease in Type 1 Diabetes

Greater A1C variation during follow-up can also predict cardiovascular disease events
By Eric Metcalf
HealthDay Reporter

THURSDAY, Dec. 10 (HealthDay News) -- In patients with type 1 diabetes, greater variability in A1C levels over time is associated with higher risk of microalbuminuria, progression of established renal disease, and cardiovascular disease (CVD) events, according to research published in the November issue of Diabetes.

Johan Wadén, M.D., of the Folkhälsan Research Center in Helsinki, Finland, and colleagues analyzed data from 2,107 subjects with type 1 diabetes who underwent a median of 13 A1C measurements over a median of 5.7 years. In addition to renal status, most of the subjects also had data related to CVD events.

The researchers found that roughly 10 percent developed a higher level of albuminuria or end-stage renal disease, and 8.6 percent had a CVD event during follow-up. In terms of renal status, progressors and nonprogressors had A1C standard deviations of 1.01 and 0.75, respectively. For CVD, these values were 0.87 versus 0.79. Furthermore, serial A1C standard deviation was found to be independently associated with renal disease progression and CVD events, even after adjusting for usual risk factors and mean A1C.

"In this study, we show that the variability of A1C predicts the development and progression of incipient and overt renal disease in patients with type 1 diabetes. These data support a recent analysis from the Diabetes Control and Complications Trial intervention where A1C variability predicted the development of diabetic nephropathy and retinopathy. We add to that study by showing the same finding for nephropathy in an observational cohort and further covering the entire spectrum of renal disease (from microalbuminuria to end-stage renal disease) in diabetes," the authors write.

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