Aims/hypothesis: The aim of this study was to determine whether long-term intra-individual variability in fasting glucose (FG) during young adulthood is associated with incident diabetes, cardiovascular disease (CVD) and mortality. Methods: We included participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study, ages 18–30 years at baseline (1985–1986) and followed with eight examinations for up to 30 years. Long-term glucose variability was assessed using the CV (CV-FG) and the absolute difference between successive FG measurements (average real variability; ARV-FG). For participants who developed any event (diabetes, CVD or mortality), FG variability measurement was censored at the examination prior to event ascertainment. We 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). Results: 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 (95% CI 1.52, 1.78) for diabetes, 1.15 (95% CI 1.01, 1.31) for CVD and 1.25 (95% CI 1.11, 1.40) for mortality. The HRs per 1 SD higher CV-FG were 1.39 (95% CI 1.21, 1.58) for diabetes, 1.32 (95% CI 1.13, 1.54) for CVD and 1.08 (95% CI 0.92, 1.27) for mortality, after adjustment. The cause-specific HRs per 1 SD higher ARV-FG were 1.29 (95% CI 1.14, 1.47) for non-CVD death and 1.05 (95% CI 0.76, 1.45) for CVD death. We did not observe evidence for effect modification of any association by sex or race. Conclusions/interpretation: Our results suggest that higher intra-individual FG variability during young adulthood before the onset of diabetes is associated with incident diabetes, CVD and mortality.
Bibliographical noteFunding Information:
MPB was partially supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health under Award Number T32HL069771 to conduct the current work. The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the NHLBI in collaboration with the University of Alabama at Birmingham (HHSN268201800005I and HHSN268201800007I), Northwestern University (HHSN268201800003I), the University of Minnesota (HHSN268201800006I) and the Kaiser Foundation Research Institute (HHSN268201800004I). The ancillary study to CARDIA (R01 DK106201, EPG, Principal Investigator) from the National Institute of Diabetes, Digestive and Kidney Diseases supported data collection for this study. The funders/sponsor of this study had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication.
EPG receives funding unrelated to the current study from Janssen Pharmaceuticals, Inc. (June 2017). APC receives research funding unrelated to the current study from Amgen, Inc. The remaining authors declare that there is no duality of interest associated with this manuscript. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the NHLBI, the National Institutes of Health or the US Department of Health and Human Services.
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
- Cardiovascular disease
- Fasting blood glucose
- Glucose variability
- Type 2 diabetes
- Young adulthood