Aims: Increased visit-to-visit glycaemic variability is independently associated with adverse outcomes in Type 2 diabetes. Our aim was to identify the patient characteristics associated with raised visit-to-visit glycaemic variability in people with Type 2 diabetes.
Methods: A case–control study was conducted to establish associations between HbA 1c variability and clinical covariates in 10 130 people with Type 2 diabetes. Variability was calculated by two metrics [sd and coefficient of variation (CV)] from a minimum of four HbA 1c readings obtained over a 4-year period. High and low variability groups were defined as the top and bottom tertile of the sd or CV, and used in logistic regression analyses including a number of clinical and biochemical covariates. The analyses were stratified into low mean (< 53 mmol/mol; 7%) and high mean (≥ 53 mmol/mol; 7%) HbA 1c groups.
Results: Findings were consistent across both HbA 1c groups and variability metrics. Treatment, independent of other factors, was the most strongly associated covariate for the risk of high HbA 1c variability. A six-fold increased risk was observed in the low HbA 1c group, between the most and least intense treatment regimens (P < 0.001). Similar findings were present in the high HbA 1c group with a three-fold increase in risk (P < 0.001). In addition, male gender, younger age, reduced HDL-cholesterol and increased BMI were all found to be independently associated with raised visit-to-visit glycaemic variability.
Conclusions: Intensive treatment resulting in low mean HbA 1c was associated with marked increase in HbA 1c variability. Irrespective of diabetes control, the greatest visit-to-visit variability was observed in young, insulin resistant men.
- Analysis of Variance
- Case-Control Studies
- Diabetes Mellitus, Type 2/blood
- Glycated Hemoglobin A/metabolism
- Insulin Resistance/physiology
- Middle Aged
- Risk Factors