Patients With High Hemoglobin A <sub>1</sub>C Trajectory Would Have Higher Risk of Herpes Zoster Infection -- A Large Hospital-Based Cohort Study

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Objective: To investigate the risks of herpes zoster (HZ) infection among heterogeneous HbA1C trajectories over 2 years after newly diagnosed Type 2 diabetes. Research Design and Methods: This retrospective cohort study was conducted by using the Chang Gung Research Database (CGRD), enrolled from the period of 1 January 2007 to 31 December 2017. We used the HbA1C data in the first 2 years newly diagnosed as Type 2 diabetes. We applied group-based trajectory modelling (GBTM) to identify the HbA1C trajectories. Multiple Cox proportional hazards regression was applied to estimate hazard ratio (HR) for HZ infection risk with adjustment of age, sex, and comorbidities. Results: This study enrolled 121,999 subjects to perform the analysis. The GBTM identified four HbA1C trajectories: ‘good control’(58.4%), ‘high-decreasing’(8.9%), ‘moderate’(25.1%), and ‘poor control’(7.6%). The mean HbA1C were 6.7%(50mmol/mol), 7.9%(63mmol/mol), 8.4%(68mmol/mol),10.7%(93mmol/mol) respectively. The risk of HZ was significantly higher in the poor control group after adjusting for age and gender with a HR=1.44(95% CI 1.26–1.64) after adjustment for confounders and comorbidities. The risk of HZ infection for the high-decreasing group (initially poor then rapidly reaching optimal control) revealed non-significant from the good control group. Conclusions: The patients with the poor glycemic control (mean HbA1C=10.7%) had the highest risk of HZ infection. The patients with initial hyperglycemia then reaching optimal control would have avoid HZ infection. Funding Statement: This work was supported by grants from Kaohsiung Chang Gung Memorial Hospital (CFRPG8H0331), and partially by the Research Center for Environmental Medicine, Kaohsiung Medical University, from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan and by Kaohsiung Medical University Research Center Grant (KMU-TC108A01). Declaration of Interests: No potential conflicts of interest relevant to this article were reported. Ethics Approval Statement: The presenting study was approved by the Institutional Review Board of Chang Gung Memorial Hospital (approval number: 201801148B0D001). The Institutional Review Board waived the need for informed consent, because all data was de-identified and anonymous.