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[IP] Re: Complications with normal HgA1c's



An article in a recent issue of Diabetes Care describes results of a study
that shows at least one complication of diabetes (atherosclerosis) is more
stronglycorrelated with  blood sugar spikes than HbA1c levels.  See abstract
below:


Postchallenge Plasma Glucose and Glycemic Spikes Are More Strongly Associated
With Atherosclerosis Than Fasting Glucose or HbA1c Level

Theodora S. Temelkova-Kurktschiev, MD, PHD, Carsta Koehler, PHD, Elena
Henkel, MD, Wolfgang Leonhardt, PHD, Katja Fuecker, Markolf Hanefeld, MD,
PHD, From the Institute for Clinical Metabolic Research, Technical University
Dresden, Dresden, Germany.


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Abstract
Objective: To observe the relationship of fasting plasma glucose (FPG),
postchallenge plasma glucose (PG) (30, 60, 90, and 120 min during an oral
glucose tolerance test [OGTT], as well as maximal PG during an OGTT,
postchallenge glucose spikes [PGS], and glucose under the OGTT curve), and
HbA1c to intima-media thickness (IMT) as a marker of atherosclerosis.
Research Design and Methods: OGTT, ultrasoundmeasurement of carotid IMT, and
various atherosclerosis risk factors, such as family history of diabetes,
obesity, and/or hyperlipoproteinemia, but without known diabetes, were
analyzed in 582 individuals aged 4070 years and at risk for type 2 diabetes.
Results: In univariate analysis, all examined glycemic parameters were
significantly correlated to IMT. The 2-h postchallenge plasma glucose showed
the strongest
odds ratio (OR) of 1.88 (1.342.63) in relation to abnormal IMT. All PG
variables, except for 30-min glucose in OGTT, showed a significant OR, whereas
the OR for HbA1c and FPG was not significant. In logistic regression analysis,
2-h PG was identified as the strongest determinant of IMT from all glycemic
parameters. The 2-h PG and PGS, but not FPG, were associated with a
significant rise of IMT in tertiles
of HbA1c. Glycemic parameters were strongly related to each other and to many
atherosclerosis risk factors. In multivariate analysis including a variety of
atherosclerosis risk factors, 2-h PG was a significant independent determinant
of IMT.
Conclusions: PG and PGS are more strongly associated with carotid IMT than FPG
and HbA1c level and modify substantially the risk for atherosclerosis,
estimated by
HbA1c alone, in a cohort at risk for diabetes and in the early diabetes
stage.

[Diabetes Care 23(12):1830-1834, 2000. ) 2000 American Diabetes Association,
Inc.]


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