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Visit-to-visit variability of clinical risk markers in relation to long-term complications in type 1 diabetes

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BACKGROUND: Clinical characteristics such as HbA 1c , systolic blood pressure (SBP), albuminuria and estimated glomerular filtration rate (eGFR) are important when treating type 1 diabetes. We investigated the variability in these measures as risk markers for micro- and macrovascular complications.

METHODS: This prospective study included 1062 individuals with type 1 diabetes. Visit-to-visit variability of HbA 1c , SBP, albuminuria and eGFR was calculated as the SD of the residuals in individual linear regression models using all available measures in a specified period of 3 years (VV). Endpoints included were as follows: cardiovascular events (CVE) defined as myocardial infarction, non-fatal stroke, or coronary or peripheral arterial intervention; end-stage kidney disease (ESKD) defined as eGFR <15 ml/min/1.73 m 2 , chronic dialysis or kidney transplantation; eGFR decline ≥30%; and mortality. Adjustment included age, sex, cholesterol, HbA 1c , SBP, body mass index, smoking, albuminuria, eGFR, and mean, intercept, slope of respective exposure variables and regression models.

RESULTS: SBP VV was significantly associated with CVE (adjusted hazard ratio per 50% increase, (CI 95%); p: 1.21 [1.05-1.39]; p = 0.008), ESKD (1.51 [1.16-1.96]; p = 0.002) and mortality (1.25 [1.09-1.44]; p = 0.002). HbA 1c VV was significantly associated with mortality (1.51 [1.30-1.75]; p < 0.001); albuminuria VV with eGFR decline (1.14 [1.08-1.20]; p = 0.024) and ESKD (1.14 [1.02-1.27]; p < 0.001), but neither CVE nor mortality. Adjusted eGFR VV was not associated with endpoints.

CONCLUSION: In type 1 diabetes, higher variability of basic clinical risk markers adds important risk stratification information for the development of micro- and macrovascular complications.

OriginalsprogEngelsk
Artikelnummere14459
TidsskriftDiabetic Medicine Online
Vol/bind38
Udgave nummer5
Sider (fra-til)e14459
ISSN1464-5491
DOI
StatusUdgivet - maj 2021

Bibliografisk note

Funding Information:
F.P. reports having received research grants from AstraZeneca, Novo Nordisk and Novartis and lecture fees from Novartis, Eli Lilly, MSD, AstraZeneca, Sanofi, Novo Nordisk and Boehringer Ingelheim and having served as a consultant for Astra Zeneca, Bayer, Amgen, Novo Nordisk and MSD. P.R. reports giving lectures for AstraZeneca, Bayer, Eli Lilly and Novo Nordisk; serving as a consultant for AstraZeneca, Bayer, Gilead, Sanofi Aventis and Novo Nordisk, with all fees given to Steno Diabetes Center Copenhagen; and having equity interest in Novo Nordisk. All other authors declare no competing interests.

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