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April 12, 2006

Glycemic Variability: A Hemoglobin A1c–Independent Risk Factor for Diabetic Complications

Author Affiliations

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).

JAMA. 2006;295(14):1707-1708. doi:10.1001/jama.295.14.1707

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 of 6.5% advocated by the American College of Endocrinology.7