HbA1c Variability and Cardiovascular Events

Due to its high and increasing prevalence, type 2 diabetes mellitus is becoming more and more of a global public health burden. Effective measures are required to prevent diabetes-related morbidity and the resulting premature death. The effect of long-term glycemic fluctuations in patients with diabetes mellitus, referred to as HbA1c variability, has been the subject of intensive discussion. Whereas the mean HbA1c value is already established as a risk factor for vascular complications, an accumulation of findings makes a compelling case that HbA1c variability adds further predictive value. Recent studies raise the possibility that a reduced HbA1c variability may inhibit hyperglycemia-related diseases without increasing the risk of hypoglycemia. Taken as a whole, the present evidence demonstrates a clear association between HbA1c variability and cardiovascular events in patients with type 1 and type 2 diabetes. Nevertheless, there exists to date no standardized definition or method of measuring HbA1c variability. To advance further research, it would be helpful to reach consensus on a precise definition of HbA1c variability. © 2016, Springer Science+Business Media New York.