Abstract
To investigate the risks of herpes zoster (HZ) infection among heterogeneous HbA1C trajectories of patients with newly diagnosed type 2 diabetes, this cohort study used data from the Chang Gung Research Database (CGRD), from the 10-year period of 1 January 2007 to 31 December 2017. We applied group-based trajectory modeling (GBTM) to identify the patterns of HbA1C trajectories, and multiple Cox proportional hazards regressions were used to estimate the hazard ratio (HR) for the risk of HZ infection with adjustment of age, sex, and comorbidities. 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 control’ (25.1%), and ‘poor control’ (7.6%) with the mean HbA1C of 6.7% (50 mmol/mol), 7.9% (63 mmol/mol), 8.4% (68 mmol/mol), and 10.7% (93 mmol/mol) respectively. The risk of HZ was significantly higher in the poor control with an 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) was nonsignificant compared to the good control group. In conclusion, the patients with poor glycemic control (mean HbA1C = 10.7%) had the highest risk of HZ infection. The patients with initial hyperglycemia then reaching optimal control could have a lower risk of HZ infection.
Highlights
Herpes zoster (HZ) is a viral infection, characterized by painful, unilateral vesicular skin rash
This study aimed to investigate the risk of HZ infection among the glycemic control that was differentiated by the distinct trajectories of HbA1C by using group-based trajectory modeling
The results suggest that the patients with poor diabetes mellitus (DM) control have a higher risk of HZ infection, but the risk would be lower if the hyperglycemia became controlled and maintained within optimal levels
Summary
Herpes zoster (HZ) is a viral infection, characterized by painful, unilateral vesicular skin rash. HZ can contribute to several complications, such as postherpetic neuralgia (PHN) and herpes zoster ophthalmicus. Both the skin rash and complications could disturb daily activity and sleep and impair the quality of life and working performance [1]. The incidence rate is 3 to 4 cases per 1000 person-years [1,2]. In Taiwan, the incidence rate is 3.62 to 4.89 cases per 1000 person-years in the general population and increases with older age according to the studies by using National Health Insurance Research Database (NHIRD) [3,4]
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