Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes
Abstract Background Both long-term glycaemic variability and arterial stiffness have been recognized as cardiovascular risk factors. This study aims to investigate whether an association between these phenomena exists in individuals with type 1 diabetes. Methods This cross-sectional study included 6...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Cardiovascular Diabetology |
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| Online Access: | https://doi.org/10.1186/s12933-023-01770-2 |
| _version_ | 1827970654777901056 |
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| author | Anniina Tynjälä Valma Harjutsalo Fanny Jansson Sigfrids Per-Henrik Groop Daniel Gordin the FinnDiane Study Group |
| author_facet | Anniina Tynjälä Valma Harjutsalo Fanny Jansson Sigfrids Per-Henrik Groop Daniel Gordin the FinnDiane Study Group |
| author_sort | Anniina Tynjälä |
| collection | DOAJ |
| description | Abstract Background Both long-term glycaemic variability and arterial stiffness have been recognized as cardiovascular risk factors. This study aims to investigate whether an association between these phenomena exists in individuals with type 1 diabetes. Methods This cross-sectional study included 673 adults (305 men, 368 women) with type 1 diabetes and combined available retrospective laboratory data on HbA1c from the preceding 10 years with outcome data on arterial stiffness and clinical variables from a comprehensive study visit. HbA1c variability was calculated as adjusted standard deviation (adj-HbA1c-SD), coefficient of variation (HbA1c-CV) and average real variability (HbA1c-ARV). As measures of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV; n = 335) and augmentation index (AIx; n = 653) were assessed using applanation tonometry. Results The study population had a mean age of 47.1 (± 12.0) years and a median duration of diabetes of 31.2 (21.2–41.3) years. The median number of HbA1c assessments per individual was 17 (12–26). All three indices of HbA1c variability were significantly correlated with both cfPWV and AIx after adjustment for sex and age (p < 0.001). In separate multivariable linear regression models, adj-HbA1c-SD and HbA1c-CV were significantly associated with cfPWV (p = 0.032 and p = 0.046, respectively) and AIx (p = 0.028 and p = 0.049, respectively), even after adjustment for HbA1c-mean. HbA1c-ARV was not associated with cfPWV or AIx in the fully adjusted models. Conclusions An association independent of HbA1c-mean was found between HbA1c variability and arterial stiffness, suggesting a need to consider multiple HbA1c metrics in studies assessing cardiovascular risk in type 1 diabetes. Longitudinal and interventional studies are needed to confirm any causal relationship and to find strategies for reducing long-term glycaemic variability. |
| first_indexed | 2024-04-09T18:57:11Z |
| format | Article |
| id | doaj.art-84342284a836402fb032c6b2394fca02 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-09T18:57:11Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-84342284a836402fb032c6b2394fca022023-04-09T11:07:16ZengBMCCardiovascular Diabetology1475-28402023-03-0122111110.1186/s12933-023-01770-2Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetesAnniina Tynjälä0Valma Harjutsalo1Fanny Jansson Sigfrids2Per-Henrik Groop3Daniel Gordin4the FinnDiane Study GroupFolkhälsan Institute of Genetics, Folkhälsan Research CenterFolkhälsan Institute of Genetics, Folkhälsan Research CenterFolkhälsan Institute of Genetics, Folkhälsan Research CenterFolkhälsan Institute of Genetics, Folkhälsan Research CenterDepartment of Nephrology, University of Helsinki and Helsinki University HospitalAbstract Background Both long-term glycaemic variability and arterial stiffness have been recognized as cardiovascular risk factors. This study aims to investigate whether an association between these phenomena exists in individuals with type 1 diabetes. Methods This cross-sectional study included 673 adults (305 men, 368 women) with type 1 diabetes and combined available retrospective laboratory data on HbA1c from the preceding 10 years with outcome data on arterial stiffness and clinical variables from a comprehensive study visit. HbA1c variability was calculated as adjusted standard deviation (adj-HbA1c-SD), coefficient of variation (HbA1c-CV) and average real variability (HbA1c-ARV). As measures of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV; n = 335) and augmentation index (AIx; n = 653) were assessed using applanation tonometry. Results The study population had a mean age of 47.1 (± 12.0) years and a median duration of diabetes of 31.2 (21.2–41.3) years. The median number of HbA1c assessments per individual was 17 (12–26). All three indices of HbA1c variability were significantly correlated with both cfPWV and AIx after adjustment for sex and age (p < 0.001). In separate multivariable linear regression models, adj-HbA1c-SD and HbA1c-CV were significantly associated with cfPWV (p = 0.032 and p = 0.046, respectively) and AIx (p = 0.028 and p = 0.049, respectively), even after adjustment for HbA1c-mean. HbA1c-ARV was not associated with cfPWV or AIx in the fully adjusted models. Conclusions An association independent of HbA1c-mean was found between HbA1c variability and arterial stiffness, suggesting a need to consider multiple HbA1c metrics in studies assessing cardiovascular risk in type 1 diabetes. Longitudinal and interventional studies are needed to confirm any causal relationship and to find strategies for reducing long-term glycaemic variability.https://doi.org/10.1186/s12933-023-01770-2Arterial stiffnessApplanation tonometryAugmentation indexCardiovascular diseaseGlycaemic variabilityHbA1c |
| spellingShingle | Anniina Tynjälä Valma Harjutsalo Fanny Jansson Sigfrids Per-Henrik Groop Daniel Gordin the FinnDiane Study Group Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes Cardiovascular Diabetology Arterial stiffness Applanation tonometry Augmentation index Cardiovascular disease Glycaemic variability HbA1c |
| title | Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes |
| title_full | Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes |
| title_fullStr | Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes |
| title_full_unstemmed | Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes |
| title_short | Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes |
| title_sort | higher hba1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes |
| topic | Arterial stiffness Applanation tonometry Augmentation index Cardiovascular disease Glycaemic variability HbA1c |
| url | https://doi.org/10.1186/s12933-023-01770-2 |
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