Abstract
IntroductionRecent studies have reported that HbA1c and lipid variability is useful for risk stratification in diabetes mellitus. The present study evaluated the predictive value of the baseline, subsequent mean of at least three measurements and variability of HbA1c and lipids for adverse outcomes.MethodsThis retrospective cohort study consists of type 1 and type 2 diabetic patients who were prescribed insulin at outpatient clinics of Hong Kong public hospitals, from 1st January to 31st December 2009. Standard deviation (SD) and coefficient of variation were used to measure the variability of HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride. The primary outcome is all-cause mortality. Secondary outcomes were diabetes-related complications.ResultThe study consists of 25,186 patients (mean age = 63.0, interquartile range [IQR] of age = 15.1 years, male = 50%). HbA1c and lipid value and variability were significant predictors of all-cause mortality. Higher HbA1c and lipid variability measures were associated with increased risks of neurological, ophthalmological and renal complications, as well as incident dementia, osteoporosis, peripheral vascular disease, ischemic heart disease, atrial fibrillation and heart failure (p < 0.05). Significant association was found between hypoglycemic frequency (p < 0.0001), HbA1c (p < 0.0001) and lipid variability against baseline neutrophil-lymphocyte ratio (NLR).ConclusionRaised variability in HbA1c and lipid parameters are associated with an elevated risk in both diabetic complications and all-cause mortality. The association between hypoglycemic frequency, baseline NLR, and both HbA1c and lipid variability implicate a role for inflammation in mediating adverse outcomes in diabetes, but this should be explored further in future studies.
Highlights
Recent studies have reported that HbA1c and lipid variability is useful for risk stratification in diabetes mellitus
Thiazolidinedione lowers the risk of neurological complications (HR = 0.718, 95% confidence interval (CI) = [0.539, 0.956], p = 0.023) and HF (HR = 0.72, 95% CI = [0.54, 0.96], p < 0.0001), whilst biguanide only lowers the risk of HF (HR = 0.62, 95% CI = [0.56, 0.68], p < 0.0001)
Sulphonylurea is associated with an increased risk of renal complications (HR = 1.29, 95% CI = [1.22, 1.36], p < 0.0001) and dementia (HR = 1.22, 95% CI = [1.08, 1.39], p = 0.002), whilst biguanide is related to ophthalmological complications (HR = 1.09, 95% CI = [0.937, 1.26], p < 0.0001)
Summary
Recent studies have reported that HbA1c and lipid variability is useful for risk stratification in diabetes mellitus. An increasing proportion of diabetic patients are elderly with multiple comorbidities, leading to a call for a more personalized and patient-centered approach in diabetic management over recent years [5,6,7] This raises the need for new parameters for monitoring diabetes, other than blood glucose, to improve the sensitivity towards the disease progression across different organ systems [8,9,10,11,12].
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