{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:04:01Z","timestamp":1790625841154,"version":"4.1.0"},"reference-count":32,"publisher":"American Diabetes Association","issue":"8","content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>There is no consensus on the importance of visit-to-visit glycemic variability in diabetes. Therefore, we assessed the effects of visit-to-visit variability (VVV) in HbA1c and fasting glucose on major outcomes in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>ADVANCE was a factorial randomized controlled trial of intensive glucose control and blood pressure lowering in patients with type 2 diabetes. VVV in the intensive glucose treatment group was defined using the SD of five measurements of HbA1c and glucose taken 3\u201324 months after randomization. Outcomes were combined macro- and microvascular events and all-cause mortality occurring post 24 months. Sensitivity analyses were performed using other indices of variability and in the standard glucose treatment group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 4,399 patients in the intensive group, an increase in VVV of HbA1c was associated with an increased risk of vascular events (P = 0.01) and with mortality (P &amp;lt; 0.001): highest versus lowest tenth hazard ratio (95% CI) 1.64 (1.05\u20132.55) and 3.31 (1.57\u20136.98), respectively, after multivariable adjustment. A clear association was also observed between VVV of fasting glucose and increased risk of vascular events (P &amp;lt; 0.001; 2.70 [1.65\u20134.42]). HbA1c variability was positively associated with the risk of macrovascular events (P = 0.02 for trend), whereas glucose variability was associated with both macro- and microvascular events (P = 0.005 and P &amp;lt; 0.001 for trend, respectively). Sensitivity analyses using other indices, and patients in the standard glucose treatment group, were broadly consistent with these results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Consistency of glycemic control is important to reduce the risks of vascular events and death in type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc14-0199","type":"journal-article","created":{"date-parts":[[2014,5,9]],"date-time":"2014-05-09T05:23:45Z","timestamp":1399613025000},"page":"2359-2365","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":319,"title":["Impact of Visit-to-Visit Glycemic Variability on the Risks of Macrovascular and Microvascular Events and All-Cause Mortality in Type 2 Diabetes: The ADVANCE Trial"],"prefix":"10.2337","volume":"37","author":[{"given":"Yoichiro","family":"Hirakawa","sequence":"first","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisatomi","family":"Arima","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Zoungas","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, Australia"},{"name":"School of Public Health, Monash University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiharu","family":"Ninomiya","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, 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