HbA1c variability as an independent risk factor for diabetic retinopathy in type 1 diabetes: a German/Austrian multicenter analysis on 35,891 patients
This study aimed to analyze the effect of HbA1c variability on the occurrence of diabetic retinopathy in type 1 diabetes patients. 35,891 patients with childhood, adolescent or adult onset of type 1 diabetes from a large multicentre survey, the German/Austrian prospective documentation system (DPV),...
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| Veröffentlicht in: | PloS one 2014-03, Vol.9 (3), p.e91137-e91137 |
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| creator | Hermann, Julia M Hammes, Hans-Peter Rami-Merhar, Birgit Rosenbauer, Joachim Schütt, Morten Siegel, Erhard Holl, Reinhard W |
| description | This study aimed to analyze the effect of HbA1c variability on the occurrence of diabetic retinopathy in type 1 diabetes patients.
35,891 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.
Kaplan-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.
In patients with type 1 diabetes, HbA1c variability adds to the risk of diabetic retinopathy independently of average metabolic control. |
| doi_str_mv | 10.1371/journal.pone.0091137 |
| format | Article |
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35,891 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.
Kaplan-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.
In patients with type 1 diabetes, HbA1c variability adds to the risk of diabetic retinopathy independently of average metabolic control.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0091137</identifier><identifier>PMID: 24609115</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Austria ; Biometrics ; Coefficient of variation ; Confidence intervals ; Diabetes ; Diabetes Mellitus, Type 1 - blood ; Diabetes Mellitus, Type 1 - complications ; Diabetic retinopathy ; Diabetic Retinopathy - blood ; Diabetic Retinopathy - complications ; Epidemiology ; Female ; Germany ; Glucose ; Glycated Hemoglobin A - metabolism ; Hemoglobin ; Humans ; Hyperglycemia ; Internal medicine ; Kaplan-Meier Estimate ; Male ; Mathematics ; Medical diagnosis ; Medicine ; Patients ; Proportional Hazards Models ; Regression models ; Risk Factors ; Statistical analysis ; Studies ; Teenagers ; Variability ; Young adults</subject><ispartof>PloS one, 2014-03, Vol.9 (3), p.e91137-e91137</ispartof><rights>2014 Hermann et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Hermann et al 2014 Hermann et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5077-c2f988acd5b9c5dd614264dfe4a989dcee37b09856746966b1b140ead9a198803</citedby><cites>FETCH-LOGICAL-c5077-c2f988acd5b9c5dd614264dfe4a989dcee37b09856746966b1b140ead9a198803</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946653/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946653/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24609115$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hermann, Julia M</creatorcontrib><creatorcontrib>Hammes, Hans-Peter</creatorcontrib><creatorcontrib>Rami-Merhar, Birgit</creatorcontrib><creatorcontrib>Rosenbauer, Joachim</creatorcontrib><creatorcontrib>Schütt, Morten</creatorcontrib><creatorcontrib>Siegel, Erhard</creatorcontrib><creatorcontrib>Holl, Reinhard W</creatorcontrib><creatorcontrib>DPV Initiative the German BMBF Competence Network Diabetes Mellitus</creatorcontrib><creatorcontrib>on behalf of the DPV Initiative the German BMBF Competence Network Diabetes Mellitus</creatorcontrib><title>HbA1c variability as an independent risk factor for diabetic retinopathy in type 1 diabetes: a German/Austrian multicenter analysis on 35,891 patients</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>This study aimed to analyze the effect of HbA1c variability on the occurrence of diabetic retinopathy in type 1 diabetes patients.
35,891 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.
Kaplan-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.
In patients with type 1 diabetes, HbA1c variability adds to the risk of diabetic retinopathy independently of average metabolic control.</description><subject>Adolescent</subject><subject>Austria</subject><subject>Biometrics</subject><subject>Coefficient of variation</subject><subject>Confidence intervals</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 1 - blood</subject><subject>Diabetes Mellitus, Type 1 - complications</subject><subject>Diabetic retinopathy</subject><subject>Diabetic Retinopathy - blood</subject><subject>Diabetic Retinopathy - complications</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Germany</subject><subject>Glucose</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Internal medicine</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Mathematics</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Patients</subject><subject>Proportional Hazards Models</subject><subject>Regression models</subject><subject>Risk Factors</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Teenagers</subject><subject>Variability</subject><subject>Young adults</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptUk1v1DAQjRCIlsI_QGCJCwd2a8cfiTkgrSpoK1XiAmdr4kxaL1k72Eml_SP8XpxuWrWIg8fWzHtv5llTFG8ZXTNesdNtmKKHfj0Ej2tKNcvZZ8Ux07xcqZLy54_eR8WrlLaUSl4r9bI4KoWaCfK4-HPRbJgltxAdNK53455AIuCJ8y0OmIMfSXTpF-nAjiGSLp82Y3F0lsQcfRhgvNlnAhn3AxK2lDF9JkDOMe7An26mNOYOnuymPhOzKMbcBfp9cokET7j8VGtGspTLxfS6eNFBn_DNcp8UP799_XF2sbr6fn55trlaWUmramXLTtc12FY22sq2VUyUSrQdCtC1bi0irxqqa6kqobRSDWuYoAitBpaJlJ8U7w-6Qx-SWb40GSap0FUtpMyIywOiDbA1Q3Q7iHsTwJm7RIjXBmK21KPpuLQdgtBIpRBKAooGeclsXWoGvM1aX5ZuU7PDdv6GCP0T0acV727Mdbg1XAulJM8CHxeBGH5PmEazc8li34PHMN3NrQTlVTk7-_AP9P_uxAFlY0gpYvcwDKNmXrN7lpnXzCxrlmnvHht5IN3vFf8LeTfR8g</recordid><startdate>20140307</startdate><enddate>20140307</enddate><creator>Hermann, Julia M</creator><creator>Hammes, Hans-Peter</creator><creator>Rami-Merhar, Birgit</creator><creator>Rosenbauer, Joachim</creator><creator>Schütt, Morten</creator><creator>Siegel, Erhard</creator><creator>Holl, Reinhard W</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20140307</creationdate><title>HbA1c variability as an independent risk factor for diabetic retinopathy in type 1 diabetes: a German/Austrian multicenter analysis on 35,891 patients</title><author>Hermann, Julia M ; Hammes, Hans-Peter ; Rami-Merhar, Birgit ; Rosenbauer, Joachim ; Schütt, Morten ; Siegel, Erhard ; Holl, Reinhard W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5077-c2f988acd5b9c5dd614264dfe4a989dcee37b09856746966b1b140ead9a198803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Austria</topic><topic>Biometrics</topic><topic>Coefficient of variation</topic><topic>Confidence intervals</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 1 - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hermann, Julia M</au><au>Hammes, Hans-Peter</au><au>Rami-Merhar, Birgit</au><au>Rosenbauer, Joachim</au><au>Schütt, Morten</au><au>Siegel, Erhard</au><au>Holl, Reinhard W</au><aucorp>DPV Initiative the German BMBF Competence Network Diabetes Mellitus</aucorp><aucorp>on behalf of the DPV Initiative the German BMBF Competence Network Diabetes Mellitus</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>HbA1c variability as an independent risk factor for diabetic retinopathy in type 1 diabetes: a German/Austrian multicenter analysis on 35,891 patients</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-03-07</date><risdate>2014</risdate><volume>9</volume><issue>3</issue><spage>e91137</spage><epage>e91137</epage><pages>e91137-e91137</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>This study aimed to analyze the effect of HbA1c variability on the occurrence of diabetic retinopathy in type 1 diabetes patients.
35,891 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.
Kaplan-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.
In patients with type 1 diabetes, HbA1c variability adds to the risk of diabetic retinopathy independently of average metabolic control.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24609115</pmid><doi>10.1371/journal.pone.0091137</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Austria Biometrics Coefficient of variation Confidence intervals Diabetes Diabetes Mellitus, Type 1 - blood Diabetes Mellitus, Type 1 - complications Diabetic retinopathy Diabetic Retinopathy - blood Diabetic Retinopathy - complications Epidemiology Female Germany Glucose Glycated Hemoglobin A - metabolism Hemoglobin Humans Hyperglycemia Internal medicine Kaplan-Meier Estimate Male Mathematics Medical diagnosis Medicine Patients Proportional Hazards Models Regression models Risk Factors Statistical analysis Studies Teenagers Variability Young adults |
| title | HbA1c variability as an independent risk factor for diabetic retinopathy in type 1 diabetes: a German/Austrian multicenter analysis on 35,891 patients |
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