Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161, Main Street, Ap Lei Chau, Hong Kong.
Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161, Main Street, Ap Lei Chau, Hong Kong.
Diabetes Metab. 2018 Nov;44(5):415-423. doi: 10.1016/j.diabet.2018.01.012. Epub 2018 Feb 3.
The current trend on diabetes management advocates replacing the paradigm from a uniform to an individualized patient-centered haemoglobin A (HbA) target, but there is no consensus on the optimal HbA level. The study aimed at examining the association between HbA and the risk of cardiovascular diseases (CVD) for diabetic patients with different characteristics, in order to identify patient-centered treatment targets.
A retrospective cohort study was conducted on 115,782 Chinese adult primary care patients with type 2 diabetes mellitus (DM) but no known CVD history, who were prescribed antidiabetic medications in 2010-2011. The cumulative mean HbA over a median follow-up period of 5.8 years was used to evaluate the relationship between HbA and CVD incidence using Cox analysis. Subgroup analyses were conducted by stratifying different baseline characteristics including gender, age, smoking status, diabetes duration, body mass index, Charlson's comorbidity index and DM treatment modalities.
For patients with a DM duration of<2years, an exponential relationship between HbA and risk of CVD was identified, suggesting that there was no threshold HbA level for CVD risk. For other diabetic patients, an HbA level of 6.8-7.2% was associated with a minimum risk for CVD and a J-shaped curvilinear association between HbA. The risk of CVD increased in patients with HbA<6.5% or ≥7.5%.
Among Chinese primary care patients at the early (<2years) disease stage, lower HbA targets (<6.5%) may be warranted to prevent CVD events whilst for all others, excessively lower HbA levels may not necessarily better and can potentially be harmful.
目前糖尿病管理的趋势主张从统一的以患者为中心的治疗模式转变为个体化的治疗模式，以血红蛋白 A（HbA）为目标，但对于最佳 HbA 水平尚未达成共识。本研究旨在探讨不同特征的糖尿病患者的 HbA 与心血管疾病（CVD）风险之间的关系，以确定以患者为中心的治疗目标。
本研究对 2010-2011 年接受抗糖尿病药物治疗的 115782 例中国成年初级保健患者进行了回顾性队列研究，这些患者患有 2 型糖尿病（DM）但无已知 CVD 病史。使用 Cox 分析评估中位随访时间为 5.8 年的累积平均 HbA 与 CVD 发生率之间的关系。通过分层不同的基线特征，包括性别、年龄、吸烟状况、糖尿病病程、体重指数、Charlson 合并症指数和 DM 治疗方式进行亚组分析。
对于病程<2 年的患者，HbA 与 CVD 风险之间存在指数关系，表明 HbA 水平与 CVD 风险之间没有阈值。对于其他糖尿病患者，HbA 水平在 6.8-7.2%时与 CVD 风险最低相关，HbA 之间存在 J 形曲线关系。HbA<6.5%或≥7.5%的患者 CVD 风险增加。
在中国初级保健患者的早期（<2 年）疾病阶段，可能需要较低的 HbA 目标（<6.5%）来预防 CVD 事件，而对于其他所有患者，HbA 水平过低可能不一定更好，并且可能存在潜在的危害。
