Association of Both Short-term and Long-term Glycemic Variability With the Development of Microalbuminuria in the ACCORD Trial

Abstract

Both long-and short-term glycemic variability have been associated with incident diabetes complications. We evalu-ated their relative and potential additive effects on incident renal complications in the Action to Control Cardiovascular Risk in Diabetes trial. A marker of short-term glycemic vari-ability, 1,5-anhydroglucitol (1,5-AG), was measured in 4,000 random 12-month postrandomization plasma samples (when hemoglobin A1c [HbA1c] was stable). Visit-to-visit fasting plasma glucose coefficient of variation (CV-FPG) was determined from 4 months postrandomization until the end point of microalbuminuria or macroalbuminuria. Using Cox proportional hazards models, high CV-FPG and low 1,5-AG were independently associated with microalbu-minuria after adjusting for clinical risk factors. However, only the CV-FPG association remained after additional ad-justment for average HbA1c. Only CV-FPG was a significant risk factor for macroalbuminuria. This post hoc analysis in-dicates that long-term rather than short-term glycemic variability better predicts the risk of renal disease in type 2 diabetes.