A1C Variability as an Independent Risk Factor for Microalbuminuria in Young People With Type 1 Diabetes

OBJECTIVE: To assess the potential association between A1C variability (A1C-SD) and microalbuminuria in young people with type 1 diabetes. RESEARCH DESIGN AND METHODS: Serially collected samples for A1C measurement were available for 1,232 subjects with childhood-onset type 1 diabetes recruited to the Oxford Regional Prospective Study and the Nephropathy Family Study. RESULTS: The median (range) number of A1C assessments was 4 (2–16). Mean intrapersonal A1C was 9.5% and A1C-SD was 0.91. Mean A1C and A1C-SD values were higher in subjects with microalbuminuria (n = 227) than in those with normoalbuminuria (10.3 vs. 9.4%; 1.12 vs. 0.86, P < 0.001). In a Cox regression model, A1C-SD was independently associated with microalbuminuria (hazard ratio 1.31 [95% CI 1.01–1.35]). CONCLUSIONS: In the current study, A1C variability was an independent variable that added to the effect of A1C on the risk for microalbuminuria in youth with type 1 diabetes, a population highly vulnerable to vascular complications.