Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Brigham and Women's Hospital Heart and Vascular Center, Department of Medicine, Harvard Medical School, Boston, MA.
Diabetes Care. 2020 Aug;43(8):1920-1928. doi: 10.2337/dc19-2541. Epub 2020 Jun 15.
To evaluate the associations between long-term change and variability in glycemia with risk of heart failure (HF) among patients with type 2 diabetes mellitus (T2DM).
Among participants with T2DM enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, variability in HbA was assessed from stabilization of HbA following enrollment (8 months) to 3 years of follow-up as follows: average successive variability (ASV) (average absolute difference between successive values), coefficient of variation (SD/mean), and SD. Participants with HF at baseline or within 3 years of enrollment were excluded. Adjusted Cox models were used to evaluate the association of percent change (from baseline to 3 years of follow-up) and variability in HbA over the first 3 years of enrollment and subsequent risk of HF.
The study included 8,576 patients. Over a median follow-up of 6.4 years from the end of variability measurements at year 3, 388 patients had an incident HF hospitalization. Substantial changes in HbA were significantly associated with higher risk of HF (hazard ratio [HR] for ≥10% decrease 1.32 [95% CI 1.08-1.75] and for ≥10% increase 1.55 [1.19-2.04]; reference <10% change in HbA). Greater long-term variability in HbA was significantly associated with higher risk of HF (HR per 1 SD of ASV 1.34 [95% CI 1.17-1.54]) independent of baseline risk factors and interval changes in cardiometabolic parameters. Consistent patterns of association were observed with use of alternative measures of glycemic variability.
Substantial long-term changes and variability in HbA were independently associated with risk of HF among patients with T2DM.
评估 2 型糖尿病（T2DM）患者血糖长期变化和变异性与心力衰竭（HF）风险之间的关系。
在参加“行动控制心血管风险糖尿病（ACCORD）”试验的 T2DM 患者中，从登记后（8 个月）HbA 稳定到 3 年随访期间，评估 HbA 的变异性如下：平均连续变异性（ASV）（连续值之间的平均绝对差异）、变异系数（SD/均值）和 SD。排除基线时有 HF 或登记后 3 年内有 HF 的患者。采用校正 Cox 模型评估 HbA 在登记后前 3 年的百分比变化（从基线到 3 年随访）和变异性与随后 HF 风险之间的关系。
该研究共纳入 8576 例患者。在从第 3 年变异性测量结束到随访 6.4 年的中位期间，388 例患者发生了 HF 住院事件。HbA 的显著变化与 HF 风险增加显著相关（HbA 降低≥10%的风险比[HR]为 1.32[95%CI 1.08-1.75]，HbA 增加≥10%的 HR 为 1.55[1.19-2.04]；HbA 变化<10%的参考值）。HbA 的长期变异性越大，HF 风险越高（每增加 1 SD 的 ASV 的 HR 为 1.34[95%CI 1.17-1.54]），独立于基线危险因素和心血管代谢参数的间隔变化。使用替代的血糖变异性测量方法观察到一致的关联模式。
HbA 的长期显著变化和变异性与 T2DM 患者 HF 风险独立相关。
