RESUMO
The incidence of diabetic nephropathy is higher in type 1 diabetic patients with associated risk factors. The within individual fluctuations in HbAlC and its effect on the development of nephropathy was not previously studied. The purpose of this study is to examine whether HbAlC fluctuations are a predictor of the development of diabetic nephropathy independent of mean HbAlC and other risk factors. One hundred and seventeen patients [64 females and 53 males] were recruited and followed up regularly at least every 3 months. The [fluctuations] in HbAlC over time was assessed. HbAlC fluctuation was defined as an increase in HbAlC of more than 2% between two consecutive measurements, or an increase of more than 1% at 2 points in time. Incipient nephropathy was present in 18 and absent in 99 patients. Mean HbAlC was significantly higher in nephropathy than in non-nephropathy patients. The effect of fluctuations on nephropathy appeared to be more significant in patients with poor metabolic control [HbAlC >/= 8%]. T1D patients who have a similar mean HbAlC may progressively behave differently in terms of developing nephropathy, depending on the fluctuations in HbAlC. This effect seems to be more pronounced among those who have higher values of HbAlC