Large visit-to-visit A1C variability is associated with an increased risk for cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM), according to a study published in Diabetes, Obesity & Metabolism. Investigators examined the association between visit-to-visit A1C variability and the risk for CVD in patients with T2DM. The analysis included 29,260 patients with at least four A1C measurements within 2 years of T2DM diagnosis. During a mean follow-up of 4.18 years, the researchers found 3,746 incident CVD cases. For the first, second, third, and fourth quartiles of A1C values, the adjusted hazard ratios for CVD were 1.00, 1.30, 1.40, and 1.59, respectively. Similar associations were seen when examining the A1C coefficient of variation and adjusted A1C standard deviations as exposures. There was also an association observed between A1C variability and risk for first and recurrent severe hypoglycemic events. Severe hypoglycemia mediated the association between A1C variability and incident CVD.