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Diabetic retinopathy linked to glycemic variability in type 2 diabetes

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November 26, 2018

Glycemic variability is more strongly associated with diabetic retinopathy in adults with type 2 diabetes than in those with latent autoimmune diabetes in adults, or LADA, according to findings published in the Journal of Diabetes Investigation.

“During recent years, glycemic variability has gained much research interest as a contributor, beyond glycated hemoglobin A1c (HbA1c), to the development of diabetes-related complications,” Jian Zhou, MD, PhD, associate professor of medicine at Shanghai Jiao Tong University and deputy director of the department of endocrinology and metabolism at Shanghai Jiao Tong University Affiliated Sixth People’s Hospital in Shanghai, and colleagues wrote. “Therefore, the aim of the present study was to evaluate the link between several short-term [glycemic variability] measurements, as assessed by CGM, and the prevalence of [diabetic retinopathy] in patients with LADA and type 2 diabetes mellitus.”

Zhou and colleagues conducted a cross-sectional analysis of 192 adults (mean age, 56.4 years; 47.9% women; mean BMI, 23.2 kg/m2) with LADA and 2,927 adults with type 2 diabetes (mean age, 57.7 years, 57.3% women, mean BMI, 25.1 kg/m2). The participants were consecutively enrolled in the first group and randomly chosen for the second. All participants were recruited from July 2005 to December 2015 at the department of endocrinology and metabolism of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital in Shanghai.

Continuous glucose monitoring was conducted on all participants for 72 hours, after which researchers calculated glycemic variability. Fundus photography was then used to confirm diabetic retinopathy.

The researchers found that diabetic retinopathy was more common among those with type 2 diabetes than in those with LADA (26.4% vs. 20.3%; P < .001). Diabetic retinopathy was significantly linked to age (OR = 1.02, 95% CI, 1.01-1.02), diabetes duration (OR = 1.11, 95% CI, 1.1-1.13), systolic blood pressure (OR = 1.02, 95% CI, 1.01-1.02), HbA1c (OR = 1.08, 95% CI, 1.04-1.13) and measurements of glycemic variability in participants with type 2 diabetes based on univariate logistic regression. In participants with LADA, diabetes duration (OR = 1.09, 95% CI, 1.03-1.15), systolic BP (OR = 1.04, 95% CI, 1.02-1.06) and diastolic BP (OR = 1.06, 95% CI, 1.01-1.1) were the lone risk factors for diabetic retinopathy. The researchers also noted that, overall, participants with LADA weighed less, had better BP and lipid profiles as well as higher glycemic variability and lower fasting C-peptide than those with type 2 diabetes.

“The present study provides evidence that intraday [glycemic variability], as assessed by CGM, is associated with the presence of [diabetic retinopathy] in type 2 diabetes mellitus patients, but not in LADA patients, suggesting that [glycemic variability] should be minimized to decrease the risk of [diabetic retinopathy] in type 2 diabetes mellitus, whereas achieving an optimal HbA1c without increasing the risk of hypoglycemia might be the primary goal in the treatment of LADA,” the researchers wrote. – by Phil Neuffer

Disclosure: Zhou reports no relevant financial disclosures. 

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