Tseng Juei-Yu, Chen Hsin-Hung, Huang Kuo-Chin, Hsu Sheng-Pang, Chen Ching-Chu
Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Department of Medicine, China Medical University, Taichung, Taiwan.
Diabetes Obes Metab. 2020 Apr;22(4):680-687. doi: 10.1111/dom.13951. Epub 2020 Jan 19.
To evaluate the effect of mean HbA1c on the correlation between HbA1c variability and all-cause mortality, and the risks associated with different levels of HbA1c and glycaemic control status in patients with type 2 diabetes.
Patients with type 2 diabetes and at least three HbA1c measurements within 12-24 months were included. HbA1c variability score, coefficient of variation (CV) and standard deviation (SD) were used to evaluate variability. A variability score of 50 was set as a cutoff to define low and high variability.
A total of 4216 patients were included, of whom 1196 died during the observation period (11.1 ± 3.2 years). All-cause mortality increased with HbA1c variability score and the quartiles of HbA1c CV and SD. The strength of this association was attenuated after adjustment for mean HbA1c, and the risks associated with HbA1c variability and glycaemic control status were similar. The highest associated risk was observed with an HbA1c variability score of >50 and mean HbA1c of ≥7.5%. Mortality risk was significantly higher with a mean HbA1c of ≤6.0% and >8.5% and of ≤6.0% and >8.0% for low and high HbA1c variability, respectively.
Mean HbA1c contributed to the correlation between HbA1c variability and all-cause mortality. The risks associated with HbA1c variability and glycaemic control status were similar. The relationship between mean HbA1c and mortality presented a J-shaped distribution for both low and high HbA1c variability.
评估平均糖化血红蛋白（HbA1c）对HbA1c变异性与全因死亡率之间相关性的影响，以及2型糖尿病患者不同HbA1c水平和血糖控制状态相关的风险。
纳入2型糖尿病患者，且在12 - 24个月内至少有三次HbA1c测量值。采用HbA1c变异性评分、变异系数（CV）和标准差（SD）评估变异性。将变异性评分50作为界定低变异性和高变异性的临界值。
共纳入4216例患者，其中1196例在观察期内死亡（11.1±3.2年）。全因死亡率随HbA1c变异性评分以及HbA1c CV和SD的四分位数增加而升高。在调整平均HbA1c后，这种关联强度减弱，且与HbA1c变异性和血糖控制状态相关的风险相似。HbA1c变异性评分>50且平均HbA1c≥7.5%时观察到最高相关风险。对于低HbA1c变异性和高HbA1c变异性，平均HbA1c≤6.0%且>8.5%以及平均HbA1c≤6.0%且>8.0%时，死亡风险显著更高。
平均HbA1c促成了HbA1c变异性与全因死亡率之间的相关性。与HbA1c变异性和血糖控制状态相关的风险相似。对于低HbA1c变异性和高HbA1c变异性，平均HbA1c与死亡率之间的关系均呈J形分布。
