{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T03:08:54Z","timestamp":1770692934085,"version":"3.49.0"},"reference-count":5,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005760","name":"University of Gothenburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005760","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Diabetol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To examine the association between within-person variability in glycated hemoglobin A1c (HbA1c) and blood pressure (BP) with retinopathy and nephropathy in type 1 diabetes (T1D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide cohort included 9,358 individuals from the Swedish National Diabetes Register with T1D &lt;5 years at inclusion (1998\u20132017) and \u22658 years follow-up. Variability in HbA1c, systolic BP (SBP), and diastolic BP (DBP) was calculated as updated SDs. Associations with microvascular complications were analyzed using logistic regression with generalized estimating equations, adjusted for demographic and clinical covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean age at inclusion was 14.2 years, mean diabetes duration 1.2 years, and 44% were female. Over 10.7 years\u2019 follow-up, retinopathy developed in 33% and nephropathy in 9.3%. SBP variability was significantly associated with pre-proliferative or proliferative retinopathy (aOR 1.13, 95% CI 1.00\u20131.27) and proliferative retinopathy\/ laser photocoagulation (1.23, 1.04\u20131.45), as well as with any albuminuria (1.15, 1.08\u20131.23) and macroalbuminuria (1.29, 1.15\u20131.45). DBP variability was associated with any albuminuria (1.11, 1.03\u20131.19) and macroalbuminuria (1.28, 1.10\u20131.50). HbA1c variability was associated with any retinopathy (1.14, 1.08\u20131.20) and any albuminuria (1.12, 1.03\u20131.21).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Beyond mean levels, higher variability in HbA1c and BP is associated with retinopathy and nephropathy. Stable BP control in patients with established retinopathy may be important to prevent progression to sight-threatening stages.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00592-025-02575-3","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T11:13:03Z","timestamp":1758107583000},"page":"2235-2238","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Retinopathy and nephropathy in type 1 diabetes: role of HbA1c and blood pressure variability"],"prefix":"10.1007","volume":"62","author":[{"given":"Pavel","family":"Fatulla","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnny","family":"Ludvigsson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrik","family":"Imberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Nystr\u00f6m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3796-9283","authenticated-orcid":false,"given":"Marcus","family":"Lind","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"2575_CR1","doi-asserted-by":"publisher","first-page":"l4894","DOI":"10.1136\/bmj.l4894","volume":"366","author":"M Lind","year":"2019","unstructured":"Lind M, Pivodic A, Svensson AM, \u00d3lafsd\u00f3ttir AF, Wedel H, Ludvigsson J (2019) HbA(1c) level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study. BMJ 366:l4894. https:\/\/doi.org\/10.1136\/bmj.l4894","journal-title":"BMJ"},{"issue":"11","key":"2575_CR2","doi-asserted-by":"publisher","first-page":"2198","DOI":"10.2337\/dc08-0864","volume":"31","author":"ES Kilpatrick","year":"2008","unstructured":"Kilpatrick ES, Rigby AS, Atkin SL (2008) A1C variability and the risk of microvascular complications in type 1 diabetes: data from the diabetes control and complications trial. Diabetes Care 31(11):2198\u20132202. https:\/\/doi.org\/10.2337\/dc08-0864","journal-title":"Diabetes Care"},{"issue":"9","key":"2575_CR3","doi-asserted-by":"publisher","first-page":"3257","DOI":"10.1210\/jc.2015-3604","volume":"101","author":"SA Virk","year":"2016","unstructured":"Virk SA, Donaghue KC, Cho YH, Benitez-Aguirre P, Hing S, Pryke A et al (2016) Association between HbA1c variability and risk of microvascular complications in adolescents with type 1 diabetes. J Clin Endocrinol Metab 101(9):3257\u20133263. https:\/\/doi.org\/10.1210\/jc.2015-3604","journal-title":"J Clin Endocrinol Metab"},{"issue":"11","key":"2575_CR4","doi-asserted-by":"publisher","first-page":"2442","DOI":"10.2337\/dc10-1000","volume":"33","author":"ES Kilpatrick","year":"2010","unstructured":"Kilpatrick ES, Rigby AS, Atkin SL (2010) The role of blood pressure variability in the development of nephropathy in type 1 diabetes. Diabetes Care 33(11):2442\u20132447. https:\/\/doi.org\/10.2337\/dc10-1000","journal-title":"Diabetes Care"},{"issue":"2","key":"2575_CR5","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1001\/jamaophthalmol.2024.5274","volume":"143","author":"S Seyed Ahmadi","year":"2025","unstructured":"Seyed Ahmadi S, Ludvigsson J, Imberg H, Nystr\u00f6m T, Lind M (2025) Risk factors for retinopathy in young adults with type 1 diabetes. JAMA Ophthalmol 143(2):184\u2013186. https:\/\/doi.org\/10.1001\/jamaophthalmol.2024.5274","journal-title":"JAMA Ophthalmol"}],"container-title":["Acta Diabetologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-025-02575-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00592-025-02575-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-025-02575-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:03:04Z","timestamp":1766512984000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00592-025-02575-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,17]]},"references-count":5,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2575"],"URL":"https:\/\/doi.org\/10.1007\/s00592-025-02575-3","relation":{},"ISSN":["1432-5233"],"issn-type":[{"value":"1432-5233","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,17]]},"assertion":[{"value":"9 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Dr Nystr\u00f6m reported receiving honoraria from AstraZeneca, Merck Sharp & Dohme, Novo Nordisk, Eli Lilly, Boehringer Ingelheim, Abbott, and Amgen. Dr Lind reported receiving grants from Eli Lilly, grants from Novo Nordisk and consulting fees from Boehringer Ingelheim, Eli Lilly, Nordicinfu Care AB, Novo Nordisk, and Rubin Medical outside the submitted work. No other disclosures were reported.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures were conducted in adherence to local ethical standards and in accordance with the 1964 Helsinki Declaration and its subsequent amendments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Each author confirms their contribution as listed, and all authors have reviewed and approved the final manuscript for submission.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}