Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
Division of Population Health and Genomics, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, Scotland, U.K.
Diabetes Care. 2020 Feb;43(2):426-432. doi: 10.2337/dc19-0823. Epub 2019 Nov 14.
To investigate the association between visit-to-visit HbA variability and cardiovascular events and microvascular complications in patients with newly diagnosed type 2 diabetes.
This retrospective cohort study analyzed patients from Tayside and Fife in the Scottish Care Information-Diabetes Collaboration (SCI-DC) who were observable from the diagnosis of diabetes and had at least five HbA measurements before the outcomes were evaluated. We used the previously reported HbA variability score (HVS), calculated as the percentage of the number of changes in HbA >0.5% (5.5 mmol/mol) among all HbA measurements within an individual. The association between HVS and 10 outcomes was assessed using Cox proportional hazards models.
We included 13,111-19,883 patients in the analyses of each outcome. The patients with HVS >60% were associated with elevated risks of all outcomes compared with the lowest quintile (for example, HVS >80 to ≤100 vs. HVS ≥0 to ≤20, hazard ratio 2.38 [95% CI 1.61-3.53] for major adverse cardiovascular events, 2.4 [1.72-3.33] for all-cause mortality, 2.4 [1.13-5.11] for atherosclerotic cardiovascular death, 2.63 [1.81-3.84] for coronary artery disease, 2.04 [1.12-3.73] for ischemic stroke, 3.23 [1.76-5.93] for heart failure, 7.4 [3.84-14.27] for diabetic retinopathy, 3.07 [2.23-4.22] for diabetic peripheral neuropathy, 5.24 [2.61-10.49] for diabetic foot ulcer, and 3.49 [2.47-4.95] for new-onset chronic kidney disease). Four sensitivity analyses, including adjustment for time-weighted average HbA, confirmed the robustness of the results.
Our study shows that higher HbA variability is associated with increased risks of all-cause mortality, cardiovascular events, and microvascular complications of diabetes independently of high HbA.
探讨初诊 2 型糖尿病患者的 HbA 变异性与心血管事件和微血管并发症之间的关系。
本回顾性队列研究分析了来自苏格兰泰赛德和法夫的苏格兰护理信息-糖尿病合作组织（SCI-DC）的患者，这些患者从糖尿病诊断开始即可观察到，并且在评估结局之前至少有 5 次 HbA 测量值。我们使用之前报道的 HbA 变异性评分（HVS），其计算方法是个体内所有 HbA 测量值中 HbA 变化>0.5%（5.5mmol/mol）的次数占比。使用 Cox 比例风险模型评估 HVS 与 10 种结局之间的关系。
每种结局分析中均纳入了 13111-19883 例患者。与最低五分位数相比，HVS>60%的患者发生所有结局的风险均升高（例如，HVS>80 至≤100 与 HVS≥0 至≤20，主要不良心血管事件的危险比 2.38 [95%CI 1.61-3.53]，全因死亡率 2.4 [1.72-3.33]，动脉粥样硬化性心血管死亡 2.4 [1.13-5.11]，冠心病 2.63 [1.81-3.84]，缺血性卒中 2.04 [1.12-3.73]，心力衰竭 3.23 [1.76-5.93]，糖尿病视网膜病变 7.4 [3.84-14.27]，糖尿病周围神经病变 3.07 [2.23-4.22]，糖尿病足溃疡 5.24 [2.61-10.49]，新发慢性肾脏病 3.49 [2.47-4.95]）。四项敏感性分析，包括对时间加权平均 HbA 的调整，均证实了结果的稳健性。
本研究表明，HbA 变异性升高与全因死亡率、心血管事件和糖尿病微血管并发症的风险增加相关，而与 HbA 升高无关。
