University of Southern California School of Pharmacy, Department of Pharmaceutical Economics & Policy, Los Angeles, California, USA.
Diabetes Care. 2011 Jan;34(1):77-83. doi: 10.2337/dc10-1318. Epub 2010 Oct 11.
Type 2 diabetes is associated with increased cardiovascular risk. The role of aggressive glycemic control in preventing cardiovascular events is unclear. A nested case-control study design was used to evaluate the association between average A1C and cardiovascular outcomes.
Adults with type 2 diabetes were identified among members of Kaiser Permanente Southern California. Type 2 diabetes was identified based on ICD-9 diagnosis codes and either A1C >7.5% or prescriptions for hypoglycemic agents. Case subjects were defined based on nonfatal myocardial infarction, nonfatal stroke, or death attributed to cardiovascular events during a 3-year window. Four type 2 diabetes control subjects were matched to each case subject based on age, sex, and index date for the corresponding case. A conditional logistic regression model was used to estimate the odds ratio of cardiovascular events and compare three patient groups based on average A1C measured in the preindex period (≤6, >6-8, >8%).
A total of 44,628 control subjects were matched to 11,157 case subjects. Patients with an average A1C ≤6% were 20% more likely to experience a cardiovascular event than the group with an average A1C of >6-8% (P < 0.0001). Patients with an average A1C >8% experienced a 16% increase in the likelihood of a cardiovascular event (P < 0.0001). We found evidence of statistical interaction with A1C category and LDL level (P = 0.0002), use of cardiovascular medications (P = 0.02), and use of antipsychotics (P = 0.001).
High-risk patients with type 2 diabetes who achieved mean A1C levels of ≤6% or failed to decrease their A1C to <8% are at increased risk for cardiovascular events.
2 型糖尿病与心血管风险增加有关。积极控制血糖预防心血管事件的作用尚不清楚。本巢式病例对照研究旨在评估平均 A1C 与心血管结局之间的关系。
在 Kaiser Permanente Southern California 的成员中确定 2 型糖尿病患者。2 型糖尿病的诊断依据为 ICD-9 诊断代码和 A1C>7.5%或降糖药物处方。病例组的定义是基于非致命性心肌梗死、非致命性中风或归因于心血管事件的死亡，其发生时间在 3 年的窗口期内。根据年龄、性别和相应病例的索引日期，为每个病例匹配 4 名 2 型糖尿病对照。采用条件逻辑回归模型估计心血管事件的比值比，并比较 3 组患者的平均 A1C（在预索引期测量，分别为≤6%、>6-8%和>8%）。
共匹配了 44628 名对照者和 11157 名病例者。平均 A1C≤6%的患者发生心血管事件的可能性比平均 A1C>6-8%的患者高 20%（P<0.0001）。平均 A1C>8%的患者发生心血管事件的可能性增加了 16%（P<0.0001）。我们发现 A1C 类别与 LDL 水平（P=0.0002）、心血管药物使用（P=0.02）和抗精神病药物使用（P=0.001）之间存在统计学交互作用的证据。
2 型糖尿病高危患者，其平均 A1C 水平达到≤6%或未能将 A1C 降至<8%，发生心血管事件的风险增加。
