Identifying the independent effect of HbA<sub>1c</sub> variability on adverse health outcomes in patients with Type 2 diabetes

Prentice, Julia C.; Pizer, Steven D.; Conlin, Paul R.

doi:10.1111/dme.13166

Cited by 40 publications

(50 citation statements)

References 28 publications

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“…Previous studies have shown increased mortality in people with Type 2 diabetes who have higher HbA 1c variability . Although it is known that HbA 1c variability increases microvascular complications in Type 1 diabetes there is no previous evidence of increased mortality in this group .…”

Section: Discussionmentioning

confidence: 92%

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HbA_1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes

et al. 2017

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Aim Despite evidence of morbidity, no evidence exists on the relationship between HbA 1c variability and mortality in Type 1 diabetes. We performed an observational study to investigate whether the association between HbA 1c variability and mortality exists in a population of people with Type 1 diabetes. As a secondary outcome, we compared onset of first hospital admission between groups.Methods People with Type 1 diabetes were identified for inclusion from the Scottish Care Information -Diabetes data set. This database includes data of all people known to have diabetes who live within Scotland. A survival analysis was carried out over a 47-month period comparing two groups; group 1 with a HbA 1c coefficient of variation (CV) above the median CV value, and group 2 with a CV below the median value. Time to death or first admission was also analysed. A Cox proportional hazard model was used to compare time to death, adjusting for appropriate covariables.Results Some 6048 individuals with Type 1 diabetes were included in the analysis. Median HbA 1c CV was 7.9. The hazard ratio (HR) for mortality for those with an HbA 1c CV above the median value is 1.5 over 47 months of follow-up (P < 0.001). HR for survival to either the first admission to hospital or death for those with an HbA 1c CV above the median value was 1.35 (95% confidence interval 1.25-1.45) over 730 days of follow-up (P < 0.001).Conclusion Our results show that people with greater HbA 1c variability have a higher rate of mortality and earlier hospital admission in Type 1 diabetes. Diabet. Med. 34, 1541-1545(2017

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Section: Discussionmentioning

confidence: 92%

“…Previous studies have shown increased mortality in people with Type 2 diabetes who have higher HbA 1c variability [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 95%

HbA_1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes

et al. 2017

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“…9 In a Japanese observational cohort study, Bouchi et al 16 observed an increased incidence of CVD in patients with higher variation in HbA1c-SD. Recently, Prentice et al 17 carried out a retrospective cohort study in veterans with type 2 diabetes and concluded that all HbA1c variability measures significantly predicted adverse outcomes. In the present study, we also found that higher HbA1c variability was associated with the presence of atherosclerosis/ CVD.…”

Section: Discussionmentioning

confidence: 99%

Haemoglobin A1c variability as an independent correlate of atherosclerosis and cardiovascular disease in Chinese type 2 diabetes

Zhou

et al. 2018

Diabetes and Vascular Disease Research

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Objective: To examine the association between haemoglobin A1c variability and macrovascular complication in type 2 diabetes. Methods: We retrospectively enrolled 5278 diabetes patients with no history of cardiovascular disease and atherosclerosis by ultrasound at their first visit to the hospital from 1999 to 2010. Patients had a median of 4 haemoglobin A1c (range = 3-9) measurements during follow-up. Average haemoglobin A1c and haemoglobin A1c variability were calculated as intra-individual mean, standard deviation, coefficient of variation and adjusted standard deviation. Cardiovascular disease events and ultrasound results were re-evaluated from the medical history at the end of the study. Results: A total of 972 patients had macrovascular complication. Compared to those without atherosclerosis/ cardiovascular disease (n = 4306), haemoglobin A1c intra-individual mean and haemoglobin A1c variability levels were significantly higher in patients with macrovascular complication (p < 0.001). Multivariable logistic regression analysis showed that haemoglobin A1c variability was associated with macrovascular complication. Moreover, 488 patients with only atherosclerosis had significantly higher haemoglobin A1c intra-individual mean and haemoglobin A1c variability values than those without atherosclerosis/cardiovascular disease (p < 0.001), but in 484 patients with cardiovascular disease incidents, only higher haemoglobin A1c intra-individual mean level was found (p = 0.004). Conclusions: In Chinese type 2 diabetes, haemoglobin A1c variability was associated with macrovascular complication. Long-term stabilization of glucose is important in diabetes management, especially in the early stage of atherosclerosis.

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“…It is well recognised that chronic hyperglycaemia, as measured by HbA1c, is the key risk factor for the development of diabetes-related micro and macrovascular complications [7,8]. Several recent studies have suggested that there are relationships between the development of micro and macrovascular complications and the variation between HbA1c values at successive clinic visits [9,10,11,12,13,14]. These changes have been termed glycaemic variability.…”

Section: Introductionmentioning

confidence: 99%

The impact of glycaemic variability on wound healing in the diabetic foot – A retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic

Dhatariya

Sin

Cheng

et al. 2018

Diabetes Research and Clinical Practice

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Identifying the independent effect of HbA_1c variability on adverse health outcomes in patients with Type 2 diabetes

Abstract: In veterans with Type 2 diabetes, greater HbA variability was associated with an increased risk of adverse long-term outcomes, independently of HbA levels and direction of change. Limiting HbA fluctuations over time may reduce complications.

Cited by 40 publications

References 28 publications

HbA_1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes

HbA_1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes

Haemoglobin A1c variability as an independent correlate of atherosclerosis and cardiovascular disease in Chinese type 2 diabetes

The impact of glycaemic variability on wound healing in the diabetic foot – A retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic

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Identifying the independent effect of HbA1c variability on adverse health outcomes in patients with Type 2 diabetes

Abstract: In veterans with Type 2 diabetes, greater HbA variability was associated with an increased risk of adverse long-term outcomes, independently of HbA levels and direction of change. Limiting HbA fluctuations over time may reduce complications.

Cited by 40 publications

References 28 publications

HbA1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes

HbA1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes

Haemoglobin A1c variability as an independent correlate of atherosclerosis and cardiovascular disease in Chinese type 2 diabetes

The impact of glycaemic variability on wound healing in the diabetic foot – A retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic

Contact Info

Product

Resources

About

Identifying the independent effect of HbA_1c variability on adverse health outcomes in patients with Type 2 diabetes

HbA_1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes

HbA_1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes