Abstract
This study evaluate association between glycemic variability and adverse vascular events in nondiabetic middle-aged adults. From 10,020 Ansung-Ansan cohort, Korean Genome, and Epidemiology Study (KoGES) data. 6,462 nondiabetic adults aged <65 years was analyzed. The mean and coefficient of variation (CV) of all biannually recorded HbA1c, fasting blood glucose(FBG), and post 2 hr blood glucose (PBG) were calculated and divided into 3 groups based on tertile of CV at each measurement, respectively. Primary endpoint was composite of Macro (composite of Coronary artery disease, Myocardial infarction, Congestive heart failure or Stroke) and Microvascular event (Creatine Clearance <60 ml/min/1.73 m2). The participants (mean age: 50 years, 50% men) were followed for a median of 9.9 (9.1–10.0) years. The high HbA1c-CV tertile (odds ratio 1.30; 1.01–1.66) was independent risk factor for microvascular events. In contrast, high FBG-CV tertile (2.32; 1.30–4.12) and PBG-CV (1.85; 1.05–3.26) was for macrovascular events. In this 10-year prespective cohort study, higher HbA1c-CV tertile was associated with higher composite of macro- and microvascular events and independent risk factor in non-DM middle-aged participants. In addition, higher tertile of FBG-CV and PBG-CV were risk factors for macrovascular events.
Highlights
Diabetes mellitus (DM) is increasing worldwide[1], and DM-related complications, including macrovascular and microvascular complications, have created significant health and social burdens
These analyses revealed that the primary outcome was significantly associated with increasing age, histories of hypertension and dyslipidemia, and a higher mean HbA1c level (HR: 1.72, 95% confidence interval [Confidence interval (CI)]: 1.31– 2.26; p < 0.001)
Significantly elevated risks of the primary outcome were observed in the highest HbA1c-coefficient of variation (CV) tertile (HR: 1.37, 95% CI: 1.08–1.70; p = 0.008) and the highest fasting blood glucose (FBG)-CV tertile (HR: 1.31, 95% CI: 1.05–1.68; p = 0.02)
Summary
Diabetes mellitus (DM) is increasing worldwide[1], and DM-related complications, including macrovascular and microvascular complications, have created significant health and social burdens. Recent observational studies have indicated that glycaemic variability might play an important role in the microvascular and macrovascular complications of type 1 and type 2 DM5,6 Those studies were limited by their inconsistent methods for assessing variability, small sample sizes, or short follow-up durations. It is unclear whether clinically significant glycaemic variability can be detected in non-diabetic individuals or individuals with pre-DM. The present study evaluated long-term follow-up data from a large cohort of middle-aged Korean adults without diabetes at baseline, in order to assess whether glycaemic variability (based on variability in HbA1c and glucose levels) contributed to the development of vascular complications in this population
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