Higher fasting blood sugar variability increases risk of diabetes, CVD and death

The higher variability of fasting blood sugar levels during young adulthood (18-30 years) before the onset of diabetes may increase the risk for diabetes, cardiovascular disease (CVD) and death, finds a recent study published in the journal Diabetologia.

Michael P. Bancks, Wake Forest University School of MedicineWinston-Salem, USA, and colleagues determined whether long-term intra-individual variability in fasting blood sugar (FG) during young adulthood is associated with incident diabetes, cardiovascular disease (CVD) and mortality.

The study included 3769 black and white participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study (aged 18–30 years at baseline [1985–1986]) and followed with eight examinations for up to 30 years. Long-term variability of glucose was measured using CV (CV-FG) and the absolute difference between successive FG measurements (average real variability; ARV-FG).

The researchers estimated HRs for incident diabetes, CVD and mortality with adjustment for demographics, baseline FG, change in FG (censor – baseline) and time-varying education, smoking, alcohol consumption, BMI, physical activity, systolic BP, BP medications, LDL-cholesterol and cholesterol medications (and incident diabetes and diabetes medications for CVD and mortality outcomes).

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Key findings include:

• Among 3769 black and white participants, there were 317 incident diabetes cases (102,677 person-years), 159 incident CVD events (110,314 person-years) and 174 deaths (111,390 person-years).


• After adjustment, HRs per 1 SD higher ARV-FG were 1.64 for diabetes, 1.15for CVD and 1.25 for mortality.


• The HRs per 1 SD higher CV-FG were 1.39 or diabetes, 1.32 for CVD and 1.08 for mortality, after adjustment.


• The cause-specific HRs per 1 SD higher ARV-FG were 1.29 for non-CVD death and 1.05 for CVD death.


• The researchers did not observe evidence for effect modification of any association by sex or race.

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"Our results suggest that higher intra-individual fasting blood sugarvariability during young adulthood before the onset of diabetes is associated with incident diabetes, CVD and mortality," concluded the authors.