CARDIOVASCULAR EVENTS (RIACE)

OBJECTIVEdTo examine the association of hemoglobin (Hb) A1c variability with microvas-cular complications in the large cohort of subjects with type 2 diabetes from the Renal Insuffi-ciency And Cardiovascular Events (RIACE) Italian Multicenter Study. RESEARCHDESIGNANDMETHODSdSerial (3–5) HbA1c values collected in a 2-year period before enrollment were available from 8,260 subjects from 9 centers (of 15,773 patients from 19 centers). HbA1c variability was measured as the intraindividual SD of 4.52 6 0.76 values. Diabetic retinopathy (DR) was assessed by dilated funduscopy. Chronic kidney disease (CKD) was defined based on albuminuria, as measured by immunonephelometry or immuno-turbidimetry, and estimated glomerular filtration rate (eGFR) was calculated from serum creat-inine. RESULTSdMedian and interquartile range of average HbA1c (HbA1c-MEAN) andHbA1c-SDwere 7.57 % (6.86–8.38) and 0.46 % (0.29–0.74), respectively. The highest prevalence of microalbuminu-ria, macroalbuminuria, reduced eGFR, albuminuric CKD phenotypes, and advanced DR was ob-servedwhenbothHbA1c parameterswere above themedian and the lowestwhenbothwere below the median. Logistic regression analyses showed that HbA1c-SD adds toHbA1c-MEAN as an independen