{"doi":"10.2337/dc20-1615","title":"Visit-to-Visit Hemoglobin A1c Variability Is Associated With the Risk of Lower-Extremity Amputation in Patients With Type 2 Diabetes","abstract":"Patients with diabetes have a 10-fold higher risk of lower-extremity amputation (LEA) than people without diabetes (1). LEA is associated with the greatest reduction in quality of life and the greatest increase in mortality and medical costs in all diabetes complications. Previous studies suggested that the mean hemoglobin A1c (HbA1c) level was associated with an increased LEA risk among patients with type 2 diabetes (2). However, emerging evidence indicates that long-term glycemic variability evaluated by clinical visit-to-visit HbA1c variability may be a better predictor of diabetes complications (3). So far, the definitions of long-term HbA1c variability are inconsistent. In most studies, standard deviation of serial HbA1c measurements (HbA1c SD) and the intrapersonal coefficient of variation of HbA1c (HbA1c CV) are often used to represent HbA1c variability. In the current study, we added a new marker—HbA1c variability score (HVS) (4)—which is more easily applied to clinical practice.\n\nWe collected data from electronic health records for patients with type 2 diabetes between 2013 and 2019 in the Louisiana Experiment Assessing Diabetes outcomes (LEAD) cohort study (5). We excluded patients who had LEA diagnosis before entry and within 2 years after the first date of diabetes diagnosis, those with incomplete baseline data, those who did not have at least four HbA1c tests within 2 …","journal":"Diabetes Care","year":2020,"id":106627,"datarank":0.31191623125197543,"base_score":2.0794415416798357,"endowment":2.0794415416798357,"self_citation_contribution":0.31191623125197543,"citation_network_contribution":0.0,"self_endowment_contribution":0.31191623125197543,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9531,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":495121,"name":"Yun Shen","orcid":"0000-0002-9850-122X","position":1,"is_corresponding":false},{"id":470287,"name":"Jian Zhou","orcid":"0000-0002-1534-2279","position":2,"is_corresponding":false},{"id":424734,"name":"Lizheng Shi","orcid":"0000-0002-7827-6766","position":3,"is_corresponding":false},{"id":513874,"name":"Elizabeth Nauman","orcid":"0009-0008-8092-7071","position":4,"is_corresponding":false},{"id":20422,"name":"Peter T. Katzmarzyk","orcid":"0000-0002-9280-6022","position":5,"is_corresponding":false},{"id":513875,"name":"Eboni G. Price‐Haywood","orcid":"0000-0003-2901-3852","position":6,"is_corresponding":false},{"id":390613,"name":"Ronald Horswell","orcid":"0000-0002-7317-7523","position":7,"is_corresponding":false},{"id":390612,"name":"San Chu","orcid":"0000-0003-3058-824X","position":8,"is_corresponding":false},{"id":513876,"name":"Alessandra N. Bazzano","orcid":"0000-0002-8299-2626","position":9,"is_corresponding":false},{"id":274800,"name":"Gang Hu","orcid":"0000-0002-6172-8017","position":10,"is_corresponding":false},{"id":495120,"name":"Yuxin Fan","orcid":"0000-0003-1561-1472","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:12:27.124515Z","pmid":"32887709","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}