Evidence map›Paper›PMID 18650371›Full record

ArticleDiabetes care2008

A1C variability and the risk of microvascular complications in type 1 diabetes: data from the Diabetes Control and Complications Trial.

Eric S Kilpatrick, Alan S Rigby, Stephen L Atkin

Registry-linked trialOpen access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetes care, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03819790 (Variability of Glucose Assessed in a Randomized Trial Comparing the Initiation of A Treatment Approach With Biosimilar Basal Insulin Analog Or a Titratable iGlarLixi combinatioN in Type 2 Diabetes Among South Asian Subjects), which is not on this map. Cited by 187 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
187citing papers in PubMed, 6 pooled it
11.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03819790 phase4completedstarted 2018, after this paper: background citation

Variability of Glucose Assessed in a Randomized Trial Comparing the Initiation of A Treatment Approach With Biosimilar Basal Insulin Analog Or a Titratable iGlarLixi combinatioN in Type 2 Diabetes Among South Asian Subjects (VARIATION 2 SA Trial)

Ran2018Enrolled119Registered outcomes30Posted comparisons0ConditionsDiabetes Mellitus, Type 2ArmsBasal insulin Basaglar/Lantus + gliclazide MR, Basal insulin glargine and lixisenatide, Metformin
PMID 18784090PMID 24898300PMID 25011946PMID 15111485PMID 27659408PMID 20403888PMID 23317344PMID 24428469PMID 24731666PMID 25409370PMID 25562265PMID 26260346other papers from this trial
Open the trial in the graph
3 · Its place in the literature

Who cites it

187 citing papers in PubMed, 6 syntheses or guidelines pooled it, 412 citations in OpenAlex.

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  5. Glucose targets for preventing diabetic kidney disease and its progression.The Cochrane database of systematic reviews · 2017
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  17. Insulin analogues in children with Type 1 diabetes: a 52-week randomized clinical trial.Diabetic medicine : a journal of the British Diabetic Association · 2013
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127 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 2 institutions in 1 country.

Eric S KilpatrickDepartment of Clinical Biochemistry, Hull Royal Infirmary, Hull, UK. eric.kilpatrick@hey.nhs.uk
Alan S Rigby
Stephen L Atkin
Hull Royal Infirmary · GBHull York Medical School · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveDebate remains as to whether short- or long-term glycemic instability confers a risk of microvascular complications in addition to that predicted by mean glycemia alone. In this study, we analyzed data from the Diabetes Control and Complications Trial (DCCT) to assess the effect of A1C variability on the risk of retinopathy and nephropathy in patients with type 1 diabetes. RESEARCH DESIGN AND

methodsA1C was collected quarterly during the DCCT in 1,441 individuals. The mean A1C and the SD of A1C variability after stabilization of glycemia (from 6 months onwards) were compared with the risk of retinopathy and nephropathy with adjustments for age, sex, disease duration, treatment group, and baseline A1C.

resultsMultivariate Cox regression showed that the variability in A1C added to mean A1C in predicting the risk of development or progression of both retinopathy (hazard ratio 2.26 for every 1% increase in A1C SD [95% CI 1.63-3.14], P < 0.0001) and nephropathy (1.80 [1.37-2.42], P < 0.0001), with the relationship a feature in conventionally treated patients in particular.

conclusionsThis study has shown that variability in A1C adds to the mean value in predicting microvascular complications in type 1 diabetes. Thus, in contrast to analyses of DCCT data investigating the effect of short-term glucose instability on complication risk, longer-term fluctuations in glycemia seem to contribute to the development of retinopathy and nephropathy in type 1 diabetes.

Indexed as

Diabetes Mellitus, Type 1Diabetic NeuropathiesDiabetic RetinopathyDisease ProgressionGlycated HemoglobinHumansProportional Hazards ModelsRisk AssessmentRisk FactorsGlycated Hemoglobin

Identifiers

PMID18650371
PMCPMC2571045
OpenAlexW1992458693

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.