Glycemic variation and cardiovascular risk in the Veterans Affairs Diabetes trial

VADT Investigators

doi:10.2337/dc18-0548

Glycemic variation and cardiovascular risk in the Veterans Affairs Diabetes trial

VADT Investigators

Health Solutions, College of (CHS)

Research output: Contribution to journal › Article › peer-review

93 Scopus citations

Abstract

OBJECTIVE: There is uncertainty about the importance of glycemic variability in cardiovascular complications in patients with type 2 diabetes. Using the Veterans Affairs Diabetes Trial (VADT), we investigated the association between variation in fasting glucose and glycated hemoglobin (HbA_1c) over time and the incidence of cardiovascular disease (CVD) and assessed whether this is influenced by intensive or standard glycemic control. RESEARCH DESIGN AND METHODS: During the VADT, fasting glucose and HbA_1c were measured every 3 months for up to 84 months in 1,791 individuals. Variability measures included coefficient of variation (CV) and average real variability (ARV) for fasting glucose and HbA_1c. Overall mean glucose and HbA_1c measures as well as their maximum and the most recent measurement were also examined. RESULTS: Variability measures (CV and ARV) of fasting glucose were significantly associated with CVD even after adjusting for other risk factors, including mean fasting glucose. When considering separately groups receiving intensive and standard glycemic control, this relationship was evident in the intensive treatment group but not in the standard group. Additional adjustment for severe hypoglycemic episodes did not alter the relationship between fasting glucose variability and CVD. Interestingly, no HbA_1c measures were associated with CVD after adjusting for multiple baseline risk factors. CONCLUSIONS: Our analysis indicates that in the VADT, variability of fasting glucose plays a role in the development of CVD complications beyond the influence of standard fasting glucose measures. The adverse consequences of fasting glucose variability on CVD appear greatest in those receiving intensive glucose control.

Original language	English (US)
Pages (from-to)	2187-2194
Number of pages	8
Journal	Diabetes Care
Volume	41
Issue number	10
DOIs	https://doi.org/10.2337/dc18-0548
State	Published - Oct 1 2018

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Advanced and Specialized Nursing

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10.2337/dc18-0548

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title = "Glycemic variation and cardiovascular risk in the Veterans Affairs Diabetes trial",

abstract = "OBJECTIVE: There is uncertainty about the importance of glycemic variability in cardiovascular complications in patients with type 2 diabetes. Using the Veterans Affairs Diabetes Trial (VADT), we investigated the association between variation in fasting glucose and glycated hemoglobin (HbA1c) over time and the incidence of cardiovascular disease (CVD) and assessed whether this is influenced by intensive or standard glycemic control. RESEARCH DESIGN AND METHODS: During the VADT, fasting glucose and HbA1c were measured every 3 months for up to 84 months in 1,791 individuals. Variability measures included coefficient of variation (CV) and average real variability (ARV) for fasting glucose and HbA1c. Overall mean glucose and HbA1c measures as well as their maximum and the most recent measurement were also examined. RESULTS: Variability measures (CV and ARV) of fasting glucose were significantly associated with CVD even after adjusting for other risk factors, including mean fasting glucose. When considering separately groups receiving intensive and standard glycemic control, this relationship was evident in the intensive treatment group but not in the standard group. Additional adjustment for severe hypoglycemic episodes did not alter the relationship between fasting glucose variability and CVD. Interestingly, no HbA1c measures were associated with CVD after adjusting for multiple baseline risk factors. CONCLUSIONS: Our analysis indicates that in the VADT, variability of fasting glucose plays a role in the development of CVD complications beyond the influence of standard fasting glucose measures. The adverse consequences of fasting glucose variability on CVD appear greatest in those receiving intensive glucose control.",

author = "{VADT Investigators} and Zhou, {Jin J.} and Schwenke, {Dawn C.} and Gideon Bahn and Peter Reaven",

note = "Funding Information: Acknowledgments. The authors acknowledge the contributions of the Hines VA Cooperative Studies Program Coordinating Center. Funding. 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 (grants R01-067690 and 5R01-094775 to P.R.) and the American Diabetes Association (to P.R.). J.J.Z. is supported by National Institutes of Health grant K01-DK-106116. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. J.J.Z. and P.R. conceived and designed the study, analyzed and interpreted the data, and wrote the manuscript. D.C.S. advised on statistical analysis and reviewed and edited the manuscript. G.B. advised on statistical analysis methods and acquired the data. P.R. was an executive committee member for the VADT. J.J.Z., D.C.S., G.B., and P.R. 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 of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented in abstract form at the 78th Scientific Sessions of the American Diabetes Association, Orlando, FL, 22–26 June 2018. Publisher Copyright: {\textcopyright} 2018 by the American Diabetes Association.",

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doi = "10.2337/dc18-0548",

language = "English (US)",

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T1 - Glycemic variation and cardiovascular risk in the Veterans Affairs Diabetes trial

AU - VADT Investigators

AU - Zhou, Jin J.

AU - Schwenke, Dawn C.

AU - Bahn, Gideon

AU - Reaven, Peter

N1 - Funding Information: Acknowledgments. The authors acknowledge the contributions of the Hines VA Cooperative Studies Program Coordinating Center. Funding. 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 (grants R01-067690 and 5R01-094775 to P.R.) and the American Diabetes Association (to P.R.). J.J.Z. is supported by National Institutes of Health grant K01-DK-106116. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. J.J.Z. and P.R. conceived and designed the study, analyzed and interpreted the data, and wrote the manuscript. D.C.S. advised on statistical analysis and reviewed and edited the manuscript. G.B. advised on statistical analysis methods and acquired the data. P.R. was an executive committee member for the VADT. J.J.Z., D.C.S., G.B., and P.R. 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 of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented in abstract form at the 78th Scientific Sessions of the American Diabetes Association, Orlando, FL, 22–26 June 2018. Publisher Copyright: © 2018 by the American Diabetes Association.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - OBJECTIVE: There is uncertainty about the importance of glycemic variability in cardiovascular complications in patients with type 2 diabetes. Using the Veterans Affairs Diabetes Trial (VADT), we investigated the association between variation in fasting glucose and glycated hemoglobin (HbA1c) over time and the incidence of cardiovascular disease (CVD) and assessed whether this is influenced by intensive or standard glycemic control. RESEARCH DESIGN AND METHODS: During the VADT, fasting glucose and HbA1c were measured every 3 months for up to 84 months in 1,791 individuals. Variability measures included coefficient of variation (CV) and average real variability (ARV) for fasting glucose and HbA1c. Overall mean glucose and HbA1c measures as well as their maximum and the most recent measurement were also examined. RESULTS: Variability measures (CV and ARV) of fasting glucose were significantly associated with CVD even after adjusting for other risk factors, including mean fasting glucose. When considering separately groups receiving intensive and standard glycemic control, this relationship was evident in the intensive treatment group but not in the standard group. Additional adjustment for severe hypoglycemic episodes did not alter the relationship between fasting glucose variability and CVD. Interestingly, no HbA1c measures were associated with CVD after adjusting for multiple baseline risk factors. CONCLUSIONS: Our analysis indicates that in the VADT, variability of fasting glucose plays a role in the development of CVD complications beyond the influence of standard fasting glucose measures. The adverse consequences of fasting glucose variability on CVD appear greatest in those receiving intensive glucose control.

AB - OBJECTIVE: There is uncertainty about the importance of glycemic variability in cardiovascular complications in patients with type 2 diabetes. Using the Veterans Affairs Diabetes Trial (VADT), we investigated the association between variation in fasting glucose and glycated hemoglobin (HbA1c) over time and the incidence of cardiovascular disease (CVD) and assessed whether this is influenced by intensive or standard glycemic control. RESEARCH DESIGN AND METHODS: During the VADT, fasting glucose and HbA1c were measured every 3 months for up to 84 months in 1,791 individuals. Variability measures included coefficient of variation (CV) and average real variability (ARV) for fasting glucose and HbA1c. Overall mean glucose and HbA1c measures as well as their maximum and the most recent measurement were also examined. RESULTS: Variability measures (CV and ARV) of fasting glucose were significantly associated with CVD even after adjusting for other risk factors, including mean fasting glucose. When considering separately groups receiving intensive and standard glycemic control, this relationship was evident in the intensive treatment group but not in the standard group. Additional adjustment for severe hypoglycemic episodes did not alter the relationship between fasting glucose variability and CVD. Interestingly, no HbA1c measures were associated with CVD after adjusting for multiple baseline risk factors. CONCLUSIONS: Our analysis indicates that in the VADT, variability of fasting glucose plays a role in the development of CVD complications beyond the influence of standard fasting glucose measures. The adverse consequences of fasting glucose variability on CVD appear greatest in those receiving intensive glucose control.

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Glycemic variation and cardiovascular risk in the Veterans Affairs Diabetes trial

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