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Glycaemic variability assessed by continuous glucose monitoring and the risk of diabetic retinopathy in latent autoimmune diabetes of the adult and type 2 diabetes.

OBJECTIVE: The relationship between glycaemic variability (GV) and diabetic complications has gained much interest and remains under debate. Moreover, the association of GV with diabetic complications has not been examined in latent autoimmune diabetes of the adult (LADA). Therefore, we evaluated the relationships among several metrics of GV with diabetic retinopathy (DR) in patients with LADA and type 2 diabetes (T2DM).

METHODS: A total of 192 patients with LADA and 2927 patients with T2DM were enrolled. After continuous glucose monitoring for 72 h, three metrics of GV including standard deviation (SD), coefficient of variation (CV), and mean amplitude of glycaemic excursions (MAGE) were calculated. DR was assessed by fundus photography performed with a digital nonmydriatic camera.

RESULTS: The prevalence of DR was 20.3% and 26.4% in LADA and T2DM (P<0.001), respectively. Generally, LADA patients had fewer cardiometabolic risk factors than T2DM patients, and all GV metrics were significantly higher in LADA than in T2DM. In the multivariate logistic regression analysis, no metrics for GV were identified as independent risk factors of DR (SD: P=0.175; CV: P=0.769; MAGE: P=0.388) in LADA. However, the SD was significantly associated with DR (OR=1.15, P=0.017) in patients with T2DM after adjusting for confounders. The independent relationships of CV and MAGE with DR (P=0.194 and P=0.251, respectively) did not reach statistical significance in T2DM.

CONCLUSION: GV is more strongly associated with DR in type 2 diabetes than in LADA, suggesting that different glucose-lowering strategies should be adopted for these two types of diabetes. This article is protected by copyright. All rights reserved.

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