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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

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.


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

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

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