ArticlePediatric diabetes2016
High hemoglobin A1c variability is associated with early risk of microalbuminuria in children with T1D.
Article in Pediatric diabetes, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- Association between glycated hemoglobin variability and risk of diabetic kidney disease and diabetic retinopathy in diabetic patients: a systematic review and meta-analysis.Frontiers in endocrinology · 2026Pooled it
- Pooled it
- Hemoglobin A1c Variability Metrics Predict Coronary Artery Calcium and Cardiovascular Events in Type 1 Diabetes: The CACTI Study.The Journal of clinical endocrinology and metabolism · 2023Trial
- Clinical relevance of short-term glycemic variability in children and adolescents with type 1 diabetes: a narrative review.Translational pediatrics · 2024Review
- The Relationship Between Parent Fear of Hypoglycemia and Youth Glycemic Control Across the Recent-Onset Period in Families of Youth with Type 1 Diabetes.International journal of behavioral medicine · 2024Article
- Challenges of CRISPR/Cas-Based Cell Therapy for Type 1 Diabetes: How Not to Engineer a "Trojan Horse".International journal of molecular sciences · 2023Review
- Examining the Relationship between Nighttime Glucose Values in Youth with Type 1 Diabetes and Parent Fear of Nighttime Hypoglycemia.Pediatric diabetes · 2023Article
- An Examination of the Glucose Management Indicator in Young Children with Type 1 Diabetes.Journal of diabetes science and technology · 2022Article
- Physical Activity, Glycemic Variability, and Parental Hypoglycemia Fear in Preschoolers With Type 1 Diabetes.Pediatric exercise science · 2022Article
- Associations Between Objective Sleep Behaviors and Blood Glucose Variability in Young Children With Type 1 Diabetes.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2021Article
- Mealtime insulin BOLUS score increases prior to clinic visits in youth with type 1 diabetes.BMJ open diabetes research & care · 2020Article
- An Intervention to Reduce Hypoglycemia Fear in Parents of Young Kids with Type 1 Diabetes Through Video-Based Telemedicine (REDCHiP): Trial Design, Feasibility, and Acceptability.Diabetes technology & therapeutics · 2020Article
- Article
- Implementing clinic-wide depression screening for pediatric diabetes: An initiative to improve healthcare processes.Pediatric diabetes · 2019Article
- Cumulative Kidney Complication Risk by 50 Years of Type 1 Diabetes: The Effects of Sex, Age, and Calendar Year at Onset.Diabetes care · 2018Article
- A Mobile App for Synchronizing Glucometer Data: Impact on Adherence and Glycemic Control Among Youths With Type 1 Diabetes in Routine Care.Journal of diabetes science and technology · 2017Article
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 2 countries.
Funding
Abstract
objectiveTo test the hypothesis that HbA1c variability, as measured by standard deviation (SD), is associated with increased risk for incident microalbuminuria and persistent microalbuminuria in pediatric type 1 diabetes (T1D).
methodsA retrospective analysis using data from electronic health records was performed on 1195 patients from a pediatric diabetes clinic network in the Midwest USA from 1993 to 2009 with ≥1 yr of T1D, ≥4 total HbA1c values, ≥2 HbA1c values/yr, ≥1 urine microalbumin. Microalbuminuria, the main outcome was defined as albumin excretion rate ≥20 mcg/min or 2 of 3 consecutive urine microalbumin/creatinine ≥30 mg/gm. Patients who had persistently high microalbumin or who were treated with an angiotensin-converting-enzyme inhibitor within 1 yr were considered to have persistent microalbuminuria. Sex, race, age, diagnosis age, and duration were covariates.
resultsMedian numbers of per-patient HbA1c and microalbumin results were 14 and 3, respectively. Median intrapersonal mean HbA1c and SD were 8.62% (70.72 mol/mol) and 1.47% (16.07 mmol/mol), respectively. The median interquartile range (IQR) of diagnosis age was 9.4 yr (6.26-12.02) and diabetes duration was 4.97 yr (2.93-7.64). A total of 172 patients (14.4%) developed microalbuminuria; 55 (4.6%) had persistent microalbuminuria. Patients with higher SD of HbA1c had shorter time to microalbuminuria. In time-dependent Cox Proportional Hazard models, updated SD of HbA1c was significantly associated with microalbuminuria [univariate hazard ratio (HR) 1.48 (1.25-1.76); multivariable HR 1.28 (1.04-1.58)], whereas updated mean HbA1c was not [univariate HR 1.08 (0.97-1.22); multivariable HR 1.05 (0.92-1.2)]. Patients with persistent microalbuminuria had similar HRs.
conclusionsHbA1c variability is independently associated with development of microalbuminuria in children with T1D, highlighting the importance of maintaining stable glycemic control in pediatric patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.