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Long-term glycemic variability was calculated as the CV of serial HbA\n                      <jats:sub>1c<\/jats:sub>\n                      measurements. DR was assessed via dilated fundus photography. The association between HbA\n                      <jats:sub>1c<\/jats:sub>\n                      CV and DR was analyzed using multivariable logistic regression adjusting for confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      DR incidence of 12.4%, mostly mild non-proliferative. The median HbA\n                      <jats:sub>1c<\/jats:sub>\n                      CV was 7.0% (53\u00a0mmol\/mol). In unadjusted bivariate analysis, the incidence of mild DR was higher in the low- glycemic variability group (CV\u2009&lt;\u20095%) compared to the high- glycemic variability group. However, the multivariable logistic regression analysis revealed that higher HbA\n                      <jats:sub>1c<\/jats:sub>\n                      CV was independently associated with the presence of DR (\u03b2\u2009=\u20090.643, P\u2009=\u20090.042), alongside diabetes duration (P\u2009&lt;\u20090.001) and age (P\u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In conclusion, in a cohort of individuals with both type 1 and type 2 diabetes and a low incidence of DR, long-term glycemic variability, estimated as HbA\n                      <jats:sub>1c<\/jats:sub>\n                      CV, was independently associated with an increased risk of this complication.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00592-026-02711-7","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T10:42:04Z","timestamp":1780569724000},"page":"1395-1402","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["HbA1c variability as an independent risk factor for diabetic retinopathy: results from a screening program"],"prefix":"10.1007","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4659-7546","authenticated-orcid":false,"given":"Maria Ida","family":"Maiorino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4955-7857","authenticated-orcid":false,"given":"Carlo","family":"Gesualdo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1503-6918","authenticated-orcid":false,"given":"Silvia","family":"Angelino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8682-6860","authenticated-orcid":false,"given":"Settimio","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8062-3958","authenticated-orcid":false,"given":"Nicole","family":"Di Martino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1688-6646","authenticated-orcid":false,"given":"Clemente","family":"Iodice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6459-5854","authenticated-orcid":false,"given":"Miriam","family":"Longo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2972-9551","authenticated-orcid":false,"given":"Lorenzo","family":"Scappaticcio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4748-321X","authenticated-orcid":false,"given":"Giuseppe","family":"Bellastella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8520-6769","authenticated-orcid":false,"given":"Francesca","family":"Simonelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3652-5154","authenticated-orcid":false,"given":"Katherine","family":"Esposito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"issue":"1 Suppl 1","key":"2711_CR1","doi-asserted-by":"publisher","first-page":"S252","DOI":"10.2337\/dc25-S012","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2025","unstructured":"American Diabetes Association Professional Practice Committee (2025) Retinopathy, neuropathy, and foot care: standards of care in diabetes-2025. 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KE received a consultancy fee from Eli Lilly and GSK and has given lectures from Eli Lilly, Sanofi, Novo Nordisk, Roche and Bayer. No other potential conflicts of interest relevant to this article were reported.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Study protocol was approved by the Medical Ethics Committee of University of Campania \u201cLuigi Vanvitelli\u201d (Prot. 0003239\/I, 01\/02\/2023). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all participants included in the study.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}