Glycemic Variability: A Hemoglobin A1c–Independent Risk Factor for Diabetic Complications
- Michael Brownlee, MD;
- Irl B. Hirsch, MD
- Author Affiliations: JDRF International Center for Diabetic Complications Research, Albert Einstein College of Medicine, Bronx, NY (Dr Brownlee); and University of Washington School of Medicine, Diabetes Care Center, Seattle (Dr Hirsch).
- Corresponding Author: Irl B. Hirsch, MD, University of Washington School of Medicine, Diabetes Care Center, 4225 Roosevelt Way NE, Suite 101, Seattle, WA 98105 (ihirsch{at}u.washington.edu).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- DIABETES MELLITUS
- HEMOGLOBIN A, GLYCOSYLATED
Diabetes affects an estimated 20.8 million individuals in the United States, 7% of the current population, and the lifetime risk of developing diabetes for those born in the year 2000 is 35%.1-2 Many of these individuals will develop diabetes-specific microvascular pathology in the retina, renal glomerulus, and peripheral nerve and accelerated atherosclerotic macrovascular disease affecting arteries that supply the heart, brain, and lower extremities. In both type 1 and type 2 diabetes, large prospective clinical studies have shown a strong relationship between time-averaged mean levels of glycemia, measured as hemoglobin A1c (HbA1c), and diabetic complications.3-4 These studies are the basis for the American Diabetes Association's current recommended treatment goal that HbA1c should be less than 7%.5 However, only about a third of patients diagnosed as having diabetes achieve that goal.6 Even fewer reach the target level for HbA1c …
