Correlation B/W Glycemic control and Microvascular complications in Type 2 Diabetes Mellitus
1Abdullah Choudhry, 2Dr Arslan Naeem, 3Nasir Jamil, 4Nadia Salam, 5Dr. Sohail Nasir, 6Dr Muhammad Shaukat
Submission: 01 January 2026 | Acceptance: 20 January 2026 | Publication: 15 February 2026,
1Assistant Professor, MBBS FCPS Medicine, Amna Inayat Medical College Sheikhupura.
2Fcps (Medicine)Senior registrar (medicine) Sialkot medical college Imran Idrees Teaching Hospital Sialkot.
3MBBS, M. Sc (Physiology), M.Phil(Physiology), M.Sc(Diabetes & Endocrinology) Assistant Professor Liaquat College of Medicine and Dentistry, Darul Sehat Hospital, Karachi, Pakistan.
4Hospital Avicenna Medical and Dental College.
5Lahore Medical and Dental college Lahore.
6Assistant professor Neprology. Gomal Medical College Dera Ismail Khan & DHQr Teaching Hospital Dera Ismail Khan KPK.
Background:Microvascular complications—retinopathy (DR), diabetic kidney disease (DKD) and diabetic peripheral neuropathy (DPN)—drive disability in type 2 diabetes mellitus (T2DM). While mean glycemia (HbA1c) remains the anchor target, emerging work implicates glycemic variability and the speed of HbA1c change. (1–9).
Aim:To quantify the association between glycemic control and microvascular complications in adults with T2DM at a tertiary center in Karachi and to explore correlates from a brief patient survey..
Methods:Cross-sectional analysis of routine clinical data (Jan 2022–Jun 2024) with a supplementary survey. Outcomes: any microvascular complication (≥1 of DR, DKD [ACR≥30 mg/g], DPN). Exposure: HbA1c (continuous and categorical). Models adjusted for age, sex, diabetes duration, SBP, LDL-C, smoking, ACEi/ARB, SGLT2i/GLP-1RA. Exploratory analyses examined FPG-CV (glycemic variability proxy) and rapid HbA1c drop (≥1.5% within ≤3 months). (1–9).
Results:Among 482 adults (mean age 55.2 y; duration 9 y; mean HbA1c 8.1%), 46% had ≥1 microvascular complication (DR 26%, DKD 30%, DPN 33%). Each 1% higher HbA1c associated with higher odds of any microvascular complication (aOR 1.28; 95% CI 1.15–1.42; p<0.001) and of DR (1.35; 1.17–1.55), DKD (1.22; 1.08–1.38) and DPN (1.21; 1.05–1.39). Prevalence rose stepwise across HbA1c categories (<7.0%→≥9.0%: 31%→63%). FPG-CV showed dose-response with DPN (aOR vs Q1: 1.22, 1.41, 1.67; p-trend=0.004). Rapid HbA1c drops were linked to early DR worsening (8.6% vs 2.7%; RR 3.2; 95% CI 1.2–8.5). (4–8,12).
Conclusion:In routine care, poorer HbA1c control correlates with higher microvascular burden, and variability—as well as rapid HbA1c change—appears clinically relevant. Programs emphasizing sustained, individualized HbA1c improvement, attention to variability, and bundle therapy per ADA/KDIGO are warranted. (1–12).
Keywords: Type 2 diabetes; HbA1c; glycemic variability; diabetic retinopathy; albuminuria; diabetic peripheral neuropathy; Pakistan..