Mean Blood Glucose and Biological Variation Have Greater Influence on HbA1c Levels Than Glucose Instability
Open Access
- 1 February 2006
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 29 (2), 352-355
- https://doi.org/10.2337/diacare.29.02.06.dc05-1594
Abstract
OBJECTIVE—Mean blood glucose (MBG) over 2–3 months is a strong predictor of HbA1c (A1C) levels. Glucose instability, the variability of blood glucose levels comprising the MBG, and biological variation in A1C (BV) have also been suggested as predictors of A1C independent of MBG. To assess the relative importance of MBG, BV, and glucose instability on A1C, we analyzed patient data from the Diabetes Control and Complications Trial (DCCT). RESEARCH DESIGN AND METHODS—A glucose profile set and sample for A1C were collected quarterly over the course of the DCCT from each participant (n = 1,441). The glucose profile set consisted of seven samples, one each drawn before and 90 min after breakfast, lunch, and dinner and one before bedtime. MBG and glucose instability (SD of blood glucose [SDBG]) were calculated as the arithmetic mean and SD of glucose profile set samples for each visit, respectively. A statistical model was developed to predict A1C from MBG, SDBG, and BV, adjusted for diabetes duration, sex, treatment group, stratum, and race. RESULTS—Data from 32,977 visits were available. The overall model was highly statistically significant (log likelihood = −41,818.75, likelihood ratio χ2[7] = 7,218.71, P > χ2 = 0.0000). MBG and BV had large influences on A1C based on their standardized coefficients. SDBG had only 1/14 of the impact of MBG and 1/10 of the impact of BV. CONCLUSIONS—MBG and BV have a large influence on A1C, whereas SDBG is relatively unimportant. Consideration of BV as well as MBG in the interpretation of A1C may enhance our ability to monitor diabetes management and predict complications.Keywords
This publication has 25 references indexed in Scilit:
- Biological Variation in HbA1c Predicts Risk of Retinopathy and Nephropathy in Type 1 DiabetesDiabetes Care, 2004
- The enzymatic defence against glycation in health, disease and therapeutics: a symposium to examine the conceptBiochemical Society Transactions, 2003
- Enzymatic deglycation – a new paradigm or an epiphenomenon?Biochemical Society Transactions, 2003
- High and low hemoglobin glycation phenotypes in type 1 diabetesJournal of Diabetes and its Complications, 2002
- A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. Meta-analysis Research Group on the Diagnosis of Diabetes Using Glycated Hemoglobin LevelsPublished by American Medical Association (AMA) ,1996
- Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications TrialKidney International, 1995
- The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes MellitusNew England Journal of Medicine, 1993
- Significance of High HbA1 Levels in Normal Glucose ToleranceDiabetes Care, 1988
- Diabetes Control and Complications Trial (DCCT): Results of Feasibility Study. The DCCT Research GroupDiabetes Care, 1987
- A new look at the statistical model identificationIEEE Transactions on Automatic Control, 1974