Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.
Department of Statistics, National Cheng Kung University, Tainan, Taiwan.
Cardiovasc Diabetol. 2020 Jul 6;19(1):105. doi: 10.1186/s12933-020-01082-9.
To assess the associations of various HbA1c measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variability score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes.
Linked data between National Cheng Kung University Hospital and Taiwan's National Health Insurance Research Database were utilized to identify the study cohort. The primary outcome was the composite MVD events (retinopathy, nephropathy, or neuropathy) occurring during the study follow-up. Cox model analyses were performed to assess the associations between HbA1c measures and MVD risk, with adjustment for patients' baseline HbA1c, demographics, comorbidities/complications, and treatments.
In the models without adjustment for baseline HbA1c, all HbA1c variability and mean measures were significantly associated with MVD risk, except HVS. With adjustment for baseline HbA1c, HbA1c-CV had the strongest association with MVD risk. For every unit of increase in HbA1c-CV, the MVD risk significantly increased by 3.42- and 2.81-fold based on the models without and with adjustment for baseline HbA1c, respectively. The associations of HbA1c variability and mean measures with MVD risk in patients with baseline HbA1c < 7.5% (58 mmol/mol) were stronger compared with those in patients with baseline HbA1c ≥ 7.5% (58 mmol/mol).
HbA1c variability, especially HbA1c-CV, can supplement conventional baseline HbA1c measure for explaining MVD risk. HbA1c variability may play a greater role in MVD outcomes among patients with relatively optimal baseline glycemic control compared to those with relatively poor baseline glycemic control.
评估各种 HbA1c 指标与 2 型糖尿病患者微血管疾病（MVD）风险的相关性，包括单一基线 HbA1c 值、总体平均值、每年更新的平均值、标准差（HbA1c-SD）、变异系数（HbA1c-CV）和 HbA1c 变异分数（HVS）。
利用国立成功大学医院与台湾全民健康保险研究数据库之间的关联数据来确定研究队列。主要结局是研究随访期间发生的复合 MVD 事件（视网膜病变、肾病或神经病）。使用 Cox 模型分析评估 HbA1c 指标与 MVD 风险之间的相关性，调整患者的基线 HbA1c、人口统计学特征、合并症/并发症和治疗。
在未调整基线 HbA1c 的模型中，所有 HbA1c 变异和平均指标均与 MVD 风险显著相关，除 HVS 外。在调整基线 HbA1c 后，HbA1c-CV 与 MVD 风险的相关性最强。基于未调整和调整基线 HbA1c 的模型，HbA1c-CV 每增加一个单位，MVD 风险分别显著增加 3.42 倍和 2.81 倍。在基线 HbA1c<7.5%（58mmol/mol）的患者中，HbA1c 变异和平均指标与 MVD 风险的相关性强于基线 HbA1c≥7.5%（58mmol/mol）的患者。
HbA1c 变异，尤其是 HbA1c-CV，可补充传统的基线 HbA1c 测量值，用于解释 MVD 风险。与基线血糖控制相对较差的患者相比，HbA1c 变异在血糖控制相对较好的患者中对 MVD 结局的作用可能更大。
