ArticlePloS one2014
HbA1c variability as an independent risk factor for diabetic retinopathy in type 1 diabetes: a German/Austrian multicenter analysis on 35,891 patients.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 2 of them syntheses that pooled it.
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The trial behind it
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Who cites it
42 citing papers in PubMed, 2 syntheses or guidelines pooled it, 95 citations in OpenAlex.
- Association between glycated hemoglobin variability and risk of diabetic kidney disease and diabetic retinopathy in diabetic patients: a systematic review and meta-analysis.Frontiers in endocrinology · 2026Pooled it
- Exploring leukocyte differential count ratio profiles as inflammatory biomarkers in diabetic retinopathy: a systematic review and meta-analysis.BMC ophthalmology · 2025Pooled it
- Hemoglobin A1c Variability Metrics Predict Coronary Artery Calcium and Cardiovascular Events in Type 1 Diabetes: The CACTI Study.The Journal of clinical endocrinology and metabolism · 2023Trial
- Effect of basal insulin supplement therapy on diabetic retinopathy in short-duration type 2 diabetes: A one-year randomized parallel-group trial.Journal of diabetes · 2019Trial
- Disordered Eating Behaviors Are Not Increased by an Intervention to Improve Diet Quality but Are Associated With Poorer Glycemic Control Among Youth With Type 1 Diabetes.Diabetes care · 2018Trial
- HbA1c variability as an independent risk factor for diabetic retinopathy: results from a screening program.Acta diabetologica · 2026Article
- Cluster Analysis in Diabetes Research: A Systematic Review Enhanced by a Cross-Sectional Study.Journal of clinical medicine · 2025Review
- The Impact of Glycemic Control on Ranibizumab Efficacy in Diabetic Retinopathy: A Retrospective Analysis.Cureus · 2025Article
- HbADiabetologia · 2024Article
- Non-diabetic nephropathy in diabetic patients: incidence, HbA1c variability and other predictive factors, and implications.International urology and nephrology · 2024Article
- HbA1c Variability as an Independent Risk Factor for Microvascular Complications in Type 1 Diabetes.Journal of diabetes science and technology · 2024Article
- Differences in retinopathy prevalence and associated risk factors across 11 countries in three continents: A cross-sectional study of 156,090 children and adolescents with type 1 diabetes.Pediatric diabetes · 2022Article
- Impact of the COVID-19 Pandemic on the Metabolic Control of Diabetic Patients in Diabetic Retinopathy and Its Screening.Journal of clinical medicine · 2022Article
- Diagnostic circulating biomarkers to detect vision-threatening diabetic retinopathy: Potential screening tool of the future?Acta ophthalmologica · 2022Review
- Significance of Glycemic Variability in Diabetes Mellitus.Internal medicine (Tokyo, Japan) · 2022Article
- Comorbidities in Recent-Onset Adult Type 1 Diabetes: A Comparison of German Cohorts.Frontiers in endocrinology · 2022Observational
- The Association Between Mean Glycated Haemoglobin or Glycaemic Variability and the Development of Retinopathy in People with Diabetes: A Retrospective Observational Cohort Study.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2021Article
- Mean and visit-to-visit variability of glycated hemoglobin, and the risk of non-alcoholic fatty liver disease.Journal of diabetes investigation · 2021Article
- The Effect of HbADiagnostics (Basel, Switzerland) · 2021Article
- HbA1c variability as an independent predictor of diabetes retinopathy in patients with type 2 diabetes.Journal of endocrinological investigation · 2021Article
Corrections and comments
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Authors and funding
8 authors at 7 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis study aimed to analyze the effect of HbA1c variability on the occurrence of diabetic retinopathy in type 1 diabetes patients. PATIENTS AND
methods35,891 patients with childhood, adolescent or adult onset of type 1 diabetes from a large multicentre survey, the German/Austrian prospective documentation system (DPV), were analysed. Cox proportional hazard models were used to examine whether intra-individual HbA1c variability expressed as variation coefficient is an independent risk factor for the occurrence of diabetic retinopathy.
resultsKaplan-Meier curves stratified by median HbA1c and variation coefficient revealed that retinopathy-free survival probability is lower when both median HbA1c and HbA1c variability are above the 50th percentile. Cox regression models confirmed this finding: After adjustment for age at diabetes onset, gender and median HbA1c, HbA1c variability was independently associated with the occurrence of diabetic retinopathy. Time-covariate interactions used to model non-proportionality indicated an effect decreasing with duration of diabetes for both median HbA1c and HbA1c variability. Predictive accuracy increased significantly when adding HbA1c variability to the Cox regression model.
conclusionsIn patients with type 1 diabetes, HbA1c variability adds to the risk of diabetic retinopathy independently of average metabolic control.
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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.