@article{c33fe7e93b73487285112ba0329b31c8,
title = "Glycaemic variation is a predictor of all-cause mortality in the Veteran Affairs Diabetes Trial",
abstract = "Diabetes is associated with substantially increased mortality. Classic risk factors explain a portion of the excess of mortality in type 2 diabetes. The aim of this study was to examine whether visit-to-visit variation in fasting glucose and haemoglobin A1c values in the Veteran Affairs Diabetes Trial were associated with all-cause mortality in patients with type 2 diabetes in addition to other comorbidity conditions, hypoglycaemic events and adverse lifestyle behaviours. The Veteran Affairs Diabetes Trial was a randomized trial that enrolled 1791 military veterans who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. During the Veteran Affairs Diabetes Trial, fasting glucose and haemoglobin A1c were measured quarterly for up to 84 months. Variability measures included coefficient of variation and average real variability. We found that variability measures (coefficient of variation and average real variability) of fasting glucose were predictors of all-cause mortality, even after adjusting for comorbidity index, mean fasting glucose and adverse lifestyle behaviour during the study. Accounting for severe hypoglycaemia did not weaken this association. Our analysis indicates that in the Veteran Affairs Diabetes Trial, longitudinal variation in fasting glucose was associated with all-cause mortality, even when accounting for standard measures of glucose control as well as comorbidity and lifestyle factors.",
keywords = "Mortality, glycaemic control, hypoglycaemia, long-term glycaemic variability, type 2 diabetes",
author = "Zhou, {Jin J.} and Juraj Koska and Gideon Bahn and Peter Reaven",
note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Veterans Affairs Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development. Additional support was received from the National Institutes of Health (R01-067690 and 5R01-094775 to P.R.) and the American Diabetes Association (to P.R.). J.J.Z. is supported by NIH grant (K01DK106116). Funding Information: The contents of this article do not represent the views of the US Department of Veterans Affairs or the United States Government. The authors also acknowledge the contributions of the Hines VA Cooperative Studies Program Coordinating Center. J.J.Z. and P.R. conceived and designed the study, analysed and interpreted the data, and wrote the manuscript. G.B. advised on statistical analysis methods and acquired the data. P.R. was an executive committee member for the VADT. All authors reviewed and edited the manuscript, approved the final version and are accountable for all aspects of the work. J.J.Z. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Glycemic Control and Complications in Diabetes Mellitus Type 2 (VADT) is registered at ClinicalTrials.gov with identifier: NCT00032487. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Veterans Affairs Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development. Additional support was received from the National Institutes of Health (R01-067690 and 5R01-094775 to P.R.) and the American Diabetes Association (to P.R.). J.J.Z. is supported by NIH grant (K01DK106116). Publisher Copyright: {\textcopyright} The Author(s) 2019.",
year = "2019",
month = mar,
day = "1",
doi = "10.1177/1479164119827598",
language = "English (US)",
volume = "16",
pages = "178--185",
journal = "Diabetes and Vascular Disease Research",
issn = "1479-1641",
publisher = "SAGE Publications Ltd",
number = "2",
}