BACKGROUND Glycemic variation has been suggested to be a risk factor for diabetes-related complications. Previous studies did not address confounding of diabetes duration, number of visits and length of follow-up. Here, we characterize glycemic variability over time and whether its relation to diabetes-related complications and mortality is independent from diabetes- and follow-up duration. MATERIALS AND METHODS Individuals with type 2 diabetes (n = 6770) from the Hoorn Diabetes Care System cohort were included in this study. The coefficient of variation (CV) was calculated over 5-year sliding intervals. People divided in quintiles based on their CV. Cox proportional hazard models were used to investigate the role of glycemic CV as risk factor in diabetes-related complications and mortality. RESULTS The coefficient of variation of glucose (FG-CV) increased with time, in contrast to HbA1c (HbA1c-CV). People with a high FG-CV were those with an early age of diabetes onset (ΔQ5-Q1 = - 2.39 years), a higher BMI (ΔQ5-Q1 = + 0.92 kg/m2), an unfavorable lipid profile, i.e. lower levels of HDL-C (ΔQ5-Q1 = - 0.06 mmol/mol) and higher triglycerides (ΔQ5-Q1 =+ 1.20 mmol/mol). People with the highest FG-CV in the first 5-year interval showed an increased risk of insulin initiation, retinopathy, macrovascular complications and mortality independent of mean glycemia, classical risk factors and medication use. For HbA1c, the associations were weaker and less consistent. CONCLUSIONS Individuals with a higher FG-CV have an unfavorable metabolic profile and have an increased risk of developing micro- and macrovascular complications and mortality. The association of HbA1c-CV with metabolic outcomes and complications was less consistent in comparison to FG-CV.

中文翻译：

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血糖和血管并发症的访视变异性：Hoorn糖尿病护理系统队列。

背景技术血糖变化被认为是糖尿病相关并发症的危险因素。先前的研究没有解决糖尿病持续时间，就诊次数和随访时间的混杂问题。在这里，我们描述了血糖随时间变化的特征，以及它与糖尿病相关并发症和死亡率的关系是否独立于糖尿病和随访时间。材料与方法本研究包括来自Hoorn Diabetes Care System队列的2型糖尿病患者（n = 6770）。在5年的滑动间隔内计算变异系数（CV）。人们根据自己的简历将他们分为五等分。使用Cox比例风险模型研究血糖CV作为糖尿病相关并发症和死亡率中的危险因素的作用。结果与HbA1c（HbA1c-CV）相比，葡萄糖的变异系数（FG-CV）随时间增加。FG-CV高的人是指糖尿病发病年龄较早的人（ΔQ5-Q1=-2.39岁），BMI较高的人（ΔQ5-Q1= + 0.92 kg / m2），脂质状况不佳，即HDL-C（ΔQ5-Q1=-0.06 mmol / mol）和更高的甘油三酸酯（ΔQ5-Q1= + 1.20 mmol / mol）。在第一个5年间隔中FG-CV最高的人显示出胰岛素起始，视网膜病变，大血管并发症和死亡率的风险增加，而与平均血糖，经典危险因素和药物使用无关。对于HbA1c，关联性较弱且一致性较弱。结论FG-CV较高的个体代谢状况不佳，发生微血管和大血管并发症及死亡的风险增加。