title: HbA₁(c) and mean blood glucose show stronger associations with cardiovascular disease risk factors than do postprandial glycaemia or glucose variability in persons with diabetes: the A1C-Derived Average Glucose (ADAG) study.
abstract: OBJECTIVE
  Increased glucose excursions and postprandial hyperglycaemia have been suggested as unique risk factors for cardiovascular disease (CVD) and mortality in patients with diabetes mellitus. Much of the evidence is based on a single 2 h glucose value after oral glucose tolerance testing in epidemiological studies. We examined the association between various indices of glycaemia measured during everyday activities and metabolic CVD risk factors in the A1C-Derived Average Glucose (ADAG) study.
  
  
  METHODS
  Participants (268 with type 1 diabetes, 159 with type 2 diabetes) completed 16 weeks of intensive continuous glucose monitoring (CGM) and self-monitoring of blood glucose (SMBG). From these data, common indices of postprandial glycaemia, overall hyperglycaemia, glucose variability and HbA₁(c) were derived. The associations between glycaemic indices and known CVD risk factors (lipids, high-sensitivity C-reactive protein and blood pressure) were explored in linear regression models.
  
  
  RESULTS
  For both diabetes types, the overall strongest associations with CVD risk factors were seen for the measures of average glycaemia (mean blood glucose and HbA₁(c)). Associations between self-monitored postprandial and fasting glucose and CVD risk factors were weaker, but significant. Measurements of blood glucose variability showed non-significant associations. Overall, calculations based on CGM were not more informative than those based on frequent SMBG.
  
  
  CONCLUSIONS
  Mean glycaemia and HbA₁(c) show consistent and stronger associations with CVD risk factors than fasting glucose or postprandial glucose levels or measures of glucose variability in patients with diabetes.
authors.affiliation: Steno Diabetes Center A/S, Gentofte, Denmark. RBrg@steno.dk
authors.forename: R
authors.initials: R
authors.lastname: Borg
authors.forename: J C
authors.initials: JC
authors.lastname: Kuenen
authors.forename: B
authors.initials: B
authors.lastname: Carstensen
authors.forename: H
authors.initials: H
authors.lastname: Zheng
authors.forename: D M
authors.initials: DM
authors.lastname: Nathan
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: J
authors.initials: J
authors.lastname: Nerup
authors.forename: K
authors.initials: K
authors.lastname: Borch-Johnsen
authors.forename: D R
authors.initials: DR
authors.lastname: Witte
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D019518:Postprandial Period; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin