Can glycaemic variability, as calculated from blood glucose self-monitoring, predict the development of complications in type 1 diabetes over a decade?

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Can glycaemic variability, as calculated from blood glucose self-monitoring, predict the development of complications in type 1 diabetes over a decade?

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Diabetes & Metabolism
Volume 34, Issue 6, December 2008, Pages 612-616

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J. Bragda a, U. Adamsona a, L.B. Bäcklund b, P.E. Linsa, E. Moberg c and P. Oskarsson c
aDepartment of Clinical Sciences, Danderyd Hospital, Division of Internal Medicine, Karolinska Institutet, 182 88 Stockholm, Sweden
bDepartment of Clinical Neuroscience, Karolinska Huddinge, Karolinska Institutet, Stockholm, Sweden
cDepartment of Diabetology and Endocrinology, Karolinska Huddinge, Karolinska Institutet, Stockholm, Sweden

Received 21 December 2007;
revised 16 April 2008;
accepted 25 April 2008.
Available online 27 September 2008.

Abstract
Aims
Is glycaemic variability an independent risk factor for the development of microvascular complications in addition to average glycaemia, as assessed by glycated haemoglobin (HbA1c)? In this study, an 11-year follow-up was carried out in patients with type 1 diabetes. The standard deviation of blood glucose (SDBG) concentration, an index of glycaemic variability, was calculated from self-monitored blood glucose data at baseline.

Methods
A total of 100 patients were randomly selected from 442 consecutive type 1 diabetic patients attending our outpatients clinic. SDBG was calculated from 70 measurements taken over a period of four weeks. Onset and progression of micro- and macrovascular complications were recorded over the 11-year follow-up.

Results
As expected, the prevalence of complications increased over time. Statistical analyses showed that HbA1c was an independent predictor of the incidence (P = 0.004) and prevalence (P = 0.01) of nephropathy. SDBG was found to be a predictor of the prevalence of peripheral neuropathy (P = 0.03), and showed borderline significance in predicting the incidence of peripheral neuropathy (P = 0.07). SDBG was also a highly significant predictor of hypoglycaemic unawareness (P = 0.001).

Conclusions
We conclude that variability of blood glucose may be important in the development of peripheral neuropathy in patients with type 1 diabetes, and that the nervous system may be particularly vulnerable to glycaemic variability.

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