Abstract
BackgroundHbA1c variability has emerged as risk factor for cardiovascular diseases in diabetes. However, the impact of HbA1c variability on cardiovascular diseases in subjects within the recommended HbA1c target has been relatively unexplored.MethodsUsing data from a large database, we studied 101,533 people with type 2 diabetes without cardiovascular diseases. HbA1c variability was expressed as quartiles of the standard deviation of HbA1c during three years (exposure phase). The primary composite outcome included non-fatal myocardial infarction, non-fatal stroke, all-cause mortality and was assessed during five years following the first three years of exposure to HbA1c variability (longitudinal phase). An expanded composite outcome including non-fatal myocardial infarction, non-fatal stroke, coronary revascularization/reperfusion procedures, peripheral revascularization procedures, and all-cause mortality was also considered, as well as a series of specific cardiovascular complications. Cox models were adjusted for a large range of risk factors and results were expressed as adjusted hazard ratios.ResultsAn association between HbA1c variability and all the outcomes considered was found. The correlation between HbA1c variability and cardiovascular complications development was confirmed in both the subgroups of subjects with a mean HbA1c ≤ 53 mmol/mol (recommended HbA1c target) or > 53 mmol/mol during the exposure phase. The risk related to HbA1c variability was higher in people with mean HbA1c ≤ 53 mmol/mol for the primary outcome (p for interaction 0.004), for the expanded secondary outcome (p for interaction 0.001) and for the stroke (p for interaction 0.001), even though HbA1c remained at the target during the follow-up.ConclusionsThese findings suggest that HbA1c variability may provide additional information for an optimized management of diabetes, particularly in people within the target of HbA1c.
Highlights
Glycated hemoglobin (HbA1c) variability has emerged as risk factor for cardiovascular diseases in diabetes
The present study evaluated the possible link between visit-to-visit HbA1c variability and the risk of cardiovascular complications among people with type 2 diabetes (T2D) and without prevalent cardiovascular diseases (CVD) at baseline, using data relative to 101,533 patients from the Swedish National Diabetes Register (NDR) [15]
To assess the relevance of glucose variability (GV) in patients considered at target according to guidelines recommendations [16], we tested the impact of HbA1c variability on the development of CVD comparing patients with a mean HbA1c ≤ 53 mmol/mol with those with a mean HbA1c > 53 mmol/mol
Summary
HbA1c variability has emerged as risk factor for cardiovascular diseases in diabetes. The impact of HbA1c variability on cardiovascular diseases in subjects within the recommended HbA1c target has been relatively unexplored. Data relative to the impact of long-term GV, assessed as visit-to-visit variability of HbA1c, on a range of cardiovascular outcomes from large, well-characterized, prospective cohorts of patients with T2D, adjusting for multiple risk factors and with proper outcome adjudication, are limited [3]. The present study evaluated the possible link between visit-to-visit HbA1c variability and the risk of cardiovascular complications among people with T2D and without prevalent CVD at baseline, using data relative to 101,533 patients from the Swedish National Diabetes Register (NDR) [15]. To assess the relevance of GV in patients considered at target according to guidelines recommendations [16], we tested the impact of HbA1c variability on the development of CVD comparing patients with a mean HbA1c ≤ 53 mmol/mol with those with a mean HbA1c > 53 mmol/mol
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
