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Article summary:
1. The Renal Insufficiency And Cardiovascular Events Italian multicentre study enrolled 15,733 patients with type 2 diabetes from 19 diabetes clinics during 2006-2008.
2. Measures of haemoglobin A1c variability (HbA1c-SD, HbA1c-AdjSD and HbA1c-CV) were found to be strong independent predictors of all-cause mortality in type 2 diabetes, even more powerful than average HbA1c in predicting mortality.
3. Mortality risk was lower for HbA1c-SD below the median and higher for HbA1c-SD above the median, regardless of whether HbA1c-MEAN was below or above the median.
Article analysis:
The article is generally trustworthy and reliable as it provides a detailed description of the study design and methodology used to evaluate various measures of haemoglobin A1c variability as independent predictors of mortality in patients with type 2 diabetes. The authors have also provided a comprehensive discussion on the underlying mechanisms that may explain why haemoglobin A1c variability is a strong predictor of all‐cause mortality in these patients.
The article does not appear to contain any promotional content or partiality towards any particular point of view. It also presents both sides equally by providing evidence for its claims and exploring counterarguments where appropriate. Furthermore, possible risks associated with haemoglobin A1c variability are noted throughout the article.
The only potential bias that could be identified is that the study population consisted exclusively of Caucasian non-dialytic patients with type 2 diabetes, which may limit its generalizability to other populations or individuals with different characteristics or medical conditions.