The Effect of HbA(1c) Variability as a Risk Measure for Microangiopathy in Type 1 Diabetes Mellitus

Background: To measure the relationship between variability in HbA(1c) and microalbuminuria (MA) and diabetic retinopathy (DR) in the long term. Methods: A prospective case-series study, was conducted on 366 Type 1 Diabetes Mellitus patients with normoalbuminuria and without diabetic retinopathy at inclusion. The cohort was followed for a period of 12 years. The Cox survival analysis was used for the multivariate statistical study. The effect of variability in microangiopathy (retinopathy and nephropathy) was evaluated by calculating the standard deviation of HbA(1c) (SD-HbA(1c)), the coefficient of variation of HbA(1c) (CV-HbA(1c)), average real variability (ARV-HbA(1c)) and variability irrespective of the mean (VIM-HbA(1c)) adjusted for the other known variables. Results: A total of 106 patients developed diabetic retinopathy (29%) and 73 microalbuminuria (19.9%). Overt diabetic nephropathy, by our definition, affected only five patients (1.36%). Statistical results show that the current age, mean HbA(1c), SD-HbA(1c) and ARV-HbA(1c) are significant in the development of diabetic retinopathy. Microalbuminuria was significant for current age, mean HbA(1c), CV-HbA(1c) and ARV-HbA(1c). Conclusions: By measuring the variability in HbA(1c), we can use SD-HbA(1c) and ARV-HbA(1c) as possible targets for judging which patients are at risk of developing DR and MA, and CV-HbA(1c) as the target for severe DR.