Most Read Articles
Natalia Reoutova, 28 May 2020

Fasting-mimicking diet (FMD) cycles in combination with endocrine therapy (ET) cause metabolic changes in hormone receptor (HR)-positive breast cancer patients analogous to those observed in animal models, where they are associated with anticancer activity.

Roshini Claire Anthony, 28 May 2020

A study from South Korea, presented at ENDO 2020, suggested that individuals who work long hours may be at risk of developing hypothyroidism.

Pearl Toh, 14 May 2020
Children with high serum insulin levels and whose parents are under stress are more likely to have asthma symptoms, suggest two studies presented at the AAAAI 2020 Meeting.

HbA1c variability strongly associated with CVD and mortality in T2DM

Natalia Reoutova
27 Mar 2020

A prospective 10-year cohort study of 147,811 Hong Kong patients with type 2 diabetes mellitus (T2DM) finds a strong association between HbA1c variability and the incidence of cardiovascular disease (CVD) as well as mortality across all age groups.

At a median follow-up of 7.4 years (1.02 million person-years), the overall number of events was 40,785, including 27,793 CVD events and 23,175 all-cause mortalities. The CVD incidence was 23.5/1,000 person-years (PY) vs 33.6 events/1,000 PY among patients with the lowest HbA1c variability (00.24 percent) vs patients with the highest HbA1c variability (≥3.0 percent). The all-cause mortality rate was 17.9 events/1,000 PY vs 33.2 events/1,000 PY in the highest vs the lowest HbA1c variability groups, while the composite incidence of CVD and all-cause mortality was 35.1 events/1,000 PY vs 52.4 events/1,000 PY. [Diabetes Obes Metab 2020, doi:10.1111/dom.14034]

“A total of 14 studies have examined the relationship between HbA1c variability and the risk of CVD and mortality among patients with T2DM … [but] most were limited by either a small sample size, low number of incident outcomes, short follow-up period, or lack of adjustments for potential confounders such as duration of diabetes, comorbidities, and baseline medications,” wrote the researchers. [Diabetes Care 2015;38:2354-2369] “This large study is the first to investigate the age-specific associations between HbA1c variability and risk CVD and mortality among Chinese patients with diabetes.”

“Positive and log-linear associations between HbA1c variability and the risk of CVD, all-cause mortality, and composite outcomes were found across all age groups,” observed the researchers.

A 28 percent greater risk of the composite outcome of CVD and all-cause mortality was observed per every 1 percent increase in HbA1c variability in the 4554 years of age group (hazard ratio [HR], 1.28; 95 percent confidence interval [CI], 1.21 to 1.35). The same increase in HbA1c variability in the 7584 years of age group was associated with only 14 percent greater risk of composite outcome (HR, 1.14; 95 percent CI, 1.11 to 1.17). “A comparable effect [of HbA1c variability on the composite outcome of CVD incidence and all-cause mortality] was observed when stratifying subjects by gender, smoking status, BMI, baseline systolic blood pressure, LDL-C levels, eGFR, and Charlson’s comorbidity index,” reported the researchers.

The HRs for risk of CVD and all-cause mortality were higher among patients with usual HbA1c level of <7.9 percent compared with patients whose usual HbA1c level was ≥8 percent (composite outcome HR for 77.9 percent group, 1.35; 95 percent CI, 1.27 to 1.42), with the highest risk observed among those whose usual HbA1c level was <7 percent (composite outcome HR, 1.83; 95 percent CI, 1.66 to 2.03). “The risk [of CVD and all-cause mortality] among patients with usual HbA1c of <7 percent vs those with usual HbA1c level of ≥8 percent was about 8 times greater,” reported the researchers.

“The HbA1c variability may provide additional valuable information as a potential predictor for the development of CVD and all-cause mortality among patients with diabetes. Clinicians should monitor HbA1c fluctuations in addition to the absolute HbA1c value,” concluded the researchers.

Editor's Recommendations
Most Read Articles
Natalia Reoutova, 28 May 2020

Fasting-mimicking diet (FMD) cycles in combination with endocrine therapy (ET) cause metabolic changes in hormone receptor (HR)-positive breast cancer patients analogous to those observed in animal models, where they are associated with anticancer activity.

Roshini Claire Anthony, 28 May 2020

A study from South Korea, presented at ENDO 2020, suggested that individuals who work long hours may be at risk of developing hypothyroidism.

Pearl Toh, 14 May 2020
Children with high serum insulin levels and whose parents are under stress are more likely to have asthma symptoms, suggest two studies presented at the AAAAI 2020 Meeting.