Clustered Metabolic Approach Using HbA1c, BP, and Aortic Augmentation Index in Type 2 Diabetes as a Tool for Risk Stratification

Abstract

Materials and Methods: Functional vascular age in 2000 patients was assessed using cardiac risk profiler (vascular profiler-genesis), over a period of 3 years and 3 months between October 2016 and January 2020. The cardiovascular interpretations generated were used for the measurement of central arterial stiffness. The metabolically healthy groups were compared with the metabolically nonhealthy groups for the relevance of the triple co-association of HbA1c, arterial stiffness, and hypertension in screening the patients in regular standard care. The mean age of the patients was 53 years. Mann–Whitney test was used for the statistical analysis. Results: The mean age was 53.3 ± 12 years. HbA1c was <7% and >7% in 530 and 1470 patients, respectively. The lipid profile in comorbid scenario (n = 2000 [M = 1170 and F = 830]) revealed mean LDL-C mg/dL values of< 100, 100–150, >150 in 1380, 520, and 100 patients, respectively. A total of 1000 patients had the duration of diabetes <5 years, 380 patients were between 5 and 10 years, and 620 patients had been diabetic for>10 years, respectively. Arterial stiffness markers-Ankle Brachial Index and Carotid-Femoral Pulse Wave Velocity (CFPWV) were assessed and cluster analyses was performed using the metabolically healthy (HbA1c <7 and aortic augmentation index @ HR75 < 14 and nonhypertensive n = 50) as compared to the metabolically unhealthy cohort (HbA1c >7 and aortic augmentation index @ HR75 > 14 and with known hypertension (n = 230). The difference in the triple co-association of HbA1c (glycemic status), hypertensive status, and arterial stiffness was statistically significant when compared between the metabolically healthy (n = 50) vs. the metabolically nonhealthy cohort all across (n = 230) (P = 0.0457) Conclusion: The clustered metabolic marker approach is a tool to identify and stratify patients with diabetes based on the metabolic risk to prevent complications and possibly improve outcomes.