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Variable HbA1c levels ‘predict nephropathy’



Patients with fluctuating HbA1c levels have a 40% increased risk of developing microalbuminuria, concludes a new study.

The Taiwanese researchers found patients with the most variation in HbA1c, measured by standard deviation from the mean of serial tests, were 37% more likely to develop microalbuminuria.

They followed more than 800 middle-aged people with type 2 diabetes over seven to five years, with all showing normal albuminuria readings at baseline. They found just three or four HbA1c measurements over the two-year period were enough to predict the complication.

They concluded their results showed the importance of getting to grips with variable HbA1c readings and getting the patients’ disease under control quickly to prevent diabetic nephropathy.

The researchers said the results suggested poor glycaemic control, even for a short time, can be ‘memorised’ and cause detrimental effects later on.

The researchers concluded: ‘To the best of our knowledge, HbA1c variability has never been used to predict clinical outcomes in patients with type 2 diabetes.’

‘Patients with high HbA1c variability often live unhealthier lifestyles and, as shown in this study, this may intensify their vulnerability to the development of diabetic nephropathy.

‘The predictability of the two-year HbA1c standard deviation for development of microalbuminuria conveys a clinical message that sustaining glycaemic control at an early stage is crucial for the management of type 2 diabetes.’

Diabetologia 2012, online 26 August