Aim

There is a paucity of studies regarding the association between long-term glycemic variability with the risk of diabetic retinopathy (DR) in patients with type 2 diabetes. Therefore, the purpose of this study is to explore the association of glycated albumin (GA) variability and HbA1c variability with the risk of DR in patients with type 2 diabetes.

Methods

This prospective cohort study included 315 inpatients with type 2 diabetes (191 males and 124 females) with at least 3 measurements of GA and HbA1c within 2 years prior to the baseline investigation. Different GA and HbA1c variability markers were calculated, including CV, variability independent of the mean (VIM), and the average real variability (ARV). Cox proportional hazard regression models were used to explore the association between visit-to-visit variability of GA and HbA1c and the risk of DR.

Results

After an average follow-up of 3.42 years, 81 patients developed incident DR. Multivariable-adjusted (diabetes duration, smoking status, systolic blood pressure, albumin to creatinine ratio, triglycerides, using fibrates, and mean HbA1c) hazard ratios of DR associated with each unit increase in GA-CV, GA-VIM, and GA-ARV were 1.05 (95% CI 1.02–1.09), 1.69 (95% CI 1.24–2.32), and 1.13 (95%CI 1.04–1.23), respectively. However, there was no significant association between visit-to-visit HbA1c variability and the risk of DR.

Conclusions

The present study indicated that visit-to-visit variability of GA can predict the risk of incident DR in patients with type 2 diabetes, and the prediction ability is independent of the average HbA1c levels.

中文翻译：

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2 型糖尿病患者糖化白蛋白的就诊间变异性与糖尿病性视网膜病变之间的关联——一项前瞻性队列研究

目标

关于 2 型糖尿病患者的长期血糖变异性与糖尿病视网膜病变 (DR) 风险之间的关联的研究很少。因此，本研究的目的是探讨 2 型糖尿病患者糖化白蛋白 (GA) 变异性和 HbA1c 变异性与 DR 风险的关系。

方法

这项前瞻性队列研究包括 315 名 2 型糖尿病住院患者（191 名男性和 124 名女性），在 基线调查前 2 年内至少进行了 3 次 GA 和 HbA1c 测量。计算了不同的 GA 和 HbA1c 变异性标记，包括 CV、独立于平均值的变异性 (VIM) 和平均实际变异性 (ARV)。Cox 比例风险回归模型用于探索 GA 和 HbA1c 的就诊间变异性与 DR 风险之间的关联。

结果

经过平均 3.42 年的随访 ，81 名患者出现了 DR。与 GA-CV、GA-VIM 和 GA-ARV 每增加一个单位相关的多变量调整（糖尿病持续时间、吸烟状况、收缩压、白蛋白与肌酐比、甘油三酯、使用贝特类药物和平均 HbA1c）风险比分别为 1.05 (95% CI 1.02–1.09)、1.69 (95% CI 1.24–2.32) 和 1.13 (95% CI 1.04–1.23)。然而，就诊间 HbA1c 变异性与 DR 风险之间没有显着关联。

结论

本研究表明，GA 的就诊间变异性可以预测 2 型糖尿病患者发生 DR 的风险，并且预测能力与平均 HbA1c 水平无关。