Abstract
BackgroundTo assess the associations of various HbA1c measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variability score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes.MethodsLinked data between National Cheng Kung University Hospital and Taiwan’s National Health Insurance Research Database were utilized to identify the study cohort. The primary outcome was the composite MVD events (retinopathy, nephropathy, or neuropathy) occurring during the study follow-up. Cox model analyses were performed to assess the associations between HbA1c measures and MVD risk, with adjustment for patients’ baseline HbA1c, demographics, comorbidities/complications, and treatments.ResultsIn the models without adjustment for baseline HbA1c, all HbA1c variability and mean measures were significantly associated with MVD risk, except HVS. With adjustment for baseline HbA1c, HbA1c-CV had the strongest association with MVD risk. For every unit of increase in HbA1c-CV, the MVD risk significantly increased by 3.42- and 2.81-fold based on the models without and with adjustment for baseline HbA1c, respectively. The associations of HbA1c variability and mean measures with MVD risk in patients with baseline HbA1c < 7.5% (58 mmol/mol) were stronger compared with those in patients with baseline HbA1c ≥ 7.5% (58 mmol/mol).ConclusionsHbA1c variability, especially HbA1c-CV, can supplement conventional baseline HbA1c measure for explaining MVD risk. HbA1c variability may play a greater role in MVD outcomes among patients with relatively optimal baseline glycemic control compared to those with relatively poor baseline glycemic control.
Highlights
To assess the associations of various Hemoglobin A1c (HbA1c) measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variabil‐ ity score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes
In patients with type 2 diabetes, cumulative evidence shows the predictive role of HbA1c variability in the risks of hypoglycemia [12], Cardiovascular disease (CVD) [13,14,15,16,17,18,19,20], and allcause mortality [15,16,17,18,19,20, 24,25,26,27,28,29,30], studies on MVDs [15, 19, 22, 31,32,33,34,35,36,37] are relatively limited and yield inconsistent results [34,35,36]
Among 1705 of study subjects, 57.5% were male, the mean age was 53.14 years (SD: 12.23 years), the mean HbA1c value at the index date (HbA1c-index) was 8.03% (64 mmol/mol) [SD: 1.83% (20.00 mmol/mol)], the mean HbA1c-SD value was 0.84% (9.20 mmol/mol), and there was a trend of slightly decrease in the yearly mean HbA1c values over a 5-year follow-up. 22% and 79% of patients were diagnosed with CVD and MVD, respectively, at the baseline
Summary
To assess the associations of various HbA1c measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variabil‐ ity score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes. In patients with type 2 diabetes, cumulative evidence shows the predictive role of HbA1c variability in the risks of hypoglycemia [12], CVDs [13,14,15,16,17,18,19,20] (such as subclinical left ventricular remodeling and dysfunction [21], reduced baroreflex sensitivity [22], and high thrombotic risk [23]), and allcause mortality [15,16,17,18,19,20, 24,25,26,27,28,29,30], studies on MVDs [15, 19, 22, 31,32,33,34,35,36,37] are relatively limited and yield inconsistent results [34,35,36]
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