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Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study

BACKGROUND: We investigate the association between mean HbA1c, HbA1c variability, and all-cause mortality and diabetes-related macrovascular complications in patients with diabetes. METHODS: We performed a retrospective cohort study using patients present in the Singapore Health Services diabetes re...

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Autores principales: Tan, Joshua Kuan, Lim, Gek Hsiang, Mohamed Salim, Nur Nasyitah, Chia, Sing Yi, Thumboo, Julian, Bee, Yong Mong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9884453/
https://www.ncbi.nlm.nih.gov/pubmed/36721457
http://dx.doi.org/10.2147/CLEP.S391749
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author Tan, Joshua Kuan
Lim, Gek Hsiang
Mohamed Salim, Nur Nasyitah
Chia, Sing Yi
Thumboo, Julian
Bee, Yong Mong
author_facet Tan, Joshua Kuan
Lim, Gek Hsiang
Mohamed Salim, Nur Nasyitah
Chia, Sing Yi
Thumboo, Julian
Bee, Yong Mong
author_sort Tan, Joshua Kuan
collection PubMed
description BACKGROUND: We investigate the association between mean HbA1c, HbA1c variability, and all-cause mortality and diabetes-related macrovascular complications in patients with diabetes. METHODS: We performed a retrospective cohort study using patients present in the Singapore Health Services diabetes registry (SDR) during 2013 to 2014. We assessed mean HbA1c using three models: a baseline mean HbA1c for 2013–14, the mean across the whole follow-up period, and a time-varying yearly updated mean. We assessed HbA1c variability at baseline using the patient’s HbA1c variability score (HVS) for 2013–14. The association between mean HbA1c, HVS, and 6 outcomes were assessed using Cox proportional hazard models. RESULTS: We included 43,837–53,934 individuals in the analysis; 99.3% had type 2 diabetes mellitus. The data showed a J-shaped distribution in adjusted hazard ratios (HRs) for all-cause mortality, ischemic heart disease, acute myocardial infarction, peripheral arterial disease, and ischemic stroke, with an increased risk of developing these outcomes at HbA1c <6% (42 mmol/mol) and ≥8% (64 mmol/mol). With the addition of HVS, the J-shaped distribution was maintained for the above outcomes, but HRs were greater at HbA1c <6.0% (42 mmol/mol) and reduced at HbA1c ≥8.0% (64 mmol/mol) when compared to models without HVS. The risk for all outcomes increased substantially with increasing glycaemic variability. CONCLUSION: Both low (<6.0% [42 mmol/mol]) and high (≥8.0% [64 mmol/mol]) levels of glycaemic control are associated with increased all-cause mortality and diabetes-related macrovascular complications. Glycaemic variability is independently associated with increased risk for these outcomes. Therefore, patients with stable glycaemic level of 6–8% (42–64mmol/mol) are at lowest risk of all-cause mortality and diabetes-related macrovascular complications.
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spelling pubmed-98844532023-01-30 Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study Tan, Joshua Kuan Lim, Gek Hsiang Mohamed Salim, Nur Nasyitah Chia, Sing Yi Thumboo, Julian Bee, Yong Mong Clin Epidemiol Original Research BACKGROUND: We investigate the association between mean HbA1c, HbA1c variability, and all-cause mortality and diabetes-related macrovascular complications in patients with diabetes. METHODS: We performed a retrospective cohort study using patients present in the Singapore Health Services diabetes registry (SDR) during 2013 to 2014. We assessed mean HbA1c using three models: a baseline mean HbA1c for 2013–14, the mean across the whole follow-up period, and a time-varying yearly updated mean. We assessed HbA1c variability at baseline using the patient’s HbA1c variability score (HVS) for 2013–14. The association between mean HbA1c, HVS, and 6 outcomes were assessed using Cox proportional hazard models. RESULTS: We included 43,837–53,934 individuals in the analysis; 99.3% had type 2 diabetes mellitus. The data showed a J-shaped distribution in adjusted hazard ratios (HRs) for all-cause mortality, ischemic heart disease, acute myocardial infarction, peripheral arterial disease, and ischemic stroke, with an increased risk of developing these outcomes at HbA1c <6% (42 mmol/mol) and ≥8% (64 mmol/mol). With the addition of HVS, the J-shaped distribution was maintained for the above outcomes, but HRs were greater at HbA1c <6.0% (42 mmol/mol) and reduced at HbA1c ≥8.0% (64 mmol/mol) when compared to models without HVS. The risk for all outcomes increased substantially with increasing glycaemic variability. CONCLUSION: Both low (<6.0% [42 mmol/mol]) and high (≥8.0% [64 mmol/mol]) levels of glycaemic control are associated with increased all-cause mortality and diabetes-related macrovascular complications. Glycaemic variability is independently associated with increased risk for these outcomes. Therefore, patients with stable glycaemic level of 6–8% (42–64mmol/mol) are at lowest risk of all-cause mortality and diabetes-related macrovascular complications. Dove 2023-01-25 /pmc/articles/PMC9884453/ /pubmed/36721457 http://dx.doi.org/10.2147/CLEP.S391749 Text en © 2023 Tan et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Tan, Joshua Kuan
Lim, Gek Hsiang
Mohamed Salim, Nur Nasyitah
Chia, Sing Yi
Thumboo, Julian
Bee, Yong Mong
Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study
title Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study
title_full Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study
title_fullStr Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study
title_full_unstemmed Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study
title_short Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study
title_sort associations between mean hba1c, hba1c variability, and both mortality and macrovascular complications in patients with diabetes mellitus: a registry-based cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9884453/
https://www.ncbi.nlm.nih.gov/pubmed/36721457
http://dx.doi.org/10.2147/CLEP.S391749
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