Hu Jiaqi, Hsu Huichun, Yuan Xiaodan, Lou Kezheng, Hsue Cunyi, Miller Joshua D, Lu Juming, Lee Yaujiunn, Lou Qingqing
Endocrinology Department, Hainan General Hospital, No.19, Xiuhua Road, Xiuying District, Haikou, 570311, Hainan, China.
Nursing College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.
J Endocrinol Invest. 2021 Jun;44(6):1229-1236. doi: 10.1007/s40618-020-01410-6. Epub 2020 Sep 8.
To evaluate the association of both mean HbA1c and HbA1c variability with DR development in patients with type 2 diabetes.
Patients with type 2 diabetes who received dilated funduscopic examination annually and who underwent at least 2-year follow-up were included in this longitudinal study. Subjects were excluded if they took less than five HbA1c measurements during the follow-up period. HbA1C variability was expressed as A1c-SD, and the mean of HbA1c (A1c-Mean) was calculated. In addition, medical history and clinical data of all subjects were collected and analyzed. According to A1c-Mean above or below the value 7% and A1c-SD above or below the population mean value 0.76%, subjects were divided into four quartiles: Q1(A1c-Mean < 7%, A1c-SD < 0.76%); Q2(A1c-Mean < 7%, A1c-SD ≥ 0.76%); Q3(A1c-Mean ≥ 7%, A1c-SD < 0.76%); Q4(A1c-Mean ≥ 7%, A1c-SD ≥ 0.76%).
3152 participants were included in the study analysis with a median follow-up period of 3.95 years (2-5 years), 17.6% (n = 556) were found to have DR, and these patients also had higher HbA1c levels (P < 0.001). Linear mixed-effect models were performed after adjusting for the characteristics of participants and the results showed that HbA1c variability is an independent risk factor for DR. Cox regression revealed that patients in Q4 group had the highest DR prevalence (HR = 1.624, P < 0.001) while Q1 group had the lowest. In addition, patients in Q2 group (HR = 1.429, P = 0.006) had a higher risk of DR than those in Q3 group (HR = 1.334, P < 0.001).
HbA1c variability is an independent predictor of DR in patients with type 2 diabetes in Asia. It may play a greater role in DR development than mean HbA1c does when the mean value of HbA1c variability index is above 0.75%, indicating that aggressive A1c lowering strategies may, in fact, contribute excessively to risk of DR in patients with type 2 diabetes; steady decline of A1c should be taken into consideration.
评估2型糖尿病患者平均糖化血红蛋白（HbA1c）及HbA1c变异性与糖尿病视网膜病变（DR）发生之间的关联。
本纵向研究纳入了每年接受散瞳眼底检查且至少随访2年的2型糖尿病患者。若受试者在随访期间糖化血红蛋白测量次数少于5次，则将其排除。HbA1c变异性用A1c标准差（A1c-SD）表示，并计算HbA1c的平均值（A1c-均值）。此外，收集并分析了所有受试者的病史和临床数据。根据A1c-均值高于或低于7%以及A1c-SD高于或低于总体均值0.76%，将受试者分为四个四分位数：Q1（A1c-均值<7%，A1c-SD<0.76%）；Q2（A1c-均值<7%，A1c-SD≥0.76%）；Q3（A1c-均值≥7%，A1c-SD<0.76%）；Q4（A1c-均值≥7%，A1c-SD≥0.76%）。
3152名参与者纳入研究分析，中位随访期为3.95年（2 - 5年），发现17.6%（n = 556）患有DR，且这些患者的HbA1c水平也更高（P < 0.001）。在对参与者特征进行调整后进行线性混合效应模型分析，结果显示HbA1c变异性是DR的独立危险因素。Cox回归显示，Q4组患者的DR患病率最高（风险比[HR]=1.624，P < 0.001），而Q1组最低。此外，Q2组患者（HR = 1.429，P = 0.006）发生DR的风险高于Q3组患者（HR = 1.334，P < 0.001）。
在亚洲2型糖尿病患者中，HbA1c变异性是DR的独立预测因素。当HbA1c变异性指数平均值高于0.75%时，它在DR发生中可能比平均HbA1c起更大作用，这表明积极的糖化血红蛋白降低策略实际上可能过度增加2型糖尿病患者发生DR的风险；应考虑糖化血红蛋白的平稳下降。
