Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China.
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.
Acta Diabetol. 2021 Feb;58(2):171-180. doi: 10.1007/s00592-020-01605-6. Epub 2020 Sep 16.
Emerging evidence suggests that HbA1c variability, in addition to HbA1c itself, can be used as a predictor for mortality. The present study aims to examine the predictive power of mean HbA1c and HbA1c variability measures for diabetic complications as well as mortality.
The retrospective observational study analyzed diabetic patients who were prescribed insulin at outpatient clinics of the Prince of Wales Hospital and Shatin Hospital, Hong Kong, from 1 January to 31 December, 2009. Standard deviation (SD), root mean square (RMS), and coefficient of variation were used as measures of HbA1c variability. The primary outcomes were all-cause and cardiovascular mortality. Secondary outcomes were diabetes-related complications.
The study cohort consists of 3424 patients, including 3137 patients with at least three HbA1c measurements. The low mean HbA1c subgroup had significantly shorter time-to-death for all-cause mortality (P < 0.001) but not cardiovascular mortality (P = 0.920). The high Hba1c subgroup showed shorter time-to-death for all-cause (P < 0.001) and cardiovascular mortality (P < 0.001). Mean Hba1c and Hba1c variability predicted all-cause as well as cardiovascular-specific mortality. In terms of secondary outcomes, mean HbA1c and HbA1c variability significantly predicted diabetic ketoacidosis/hyperosmolar hyperglycemic state/diabetic coma, neurological, ophthalmological, and renal complications. A significant association between dichotomized HbA1c variability and hypoglycemia frequency was found (P < 0.0001).
High HbA1c variability is associated with increased risk of all-cause and cardiovascular mortality, as well as diabetic complications. The association between hypoglycemic frequency, HbA1c variability, and mortality suggests that intermittent hypoglycemia resulting in poorer outcomes in diabetic patients.
新出现的证据表明，糖化血红蛋白（HbA1c）变异性除了本身之外，还可以用作预测死亡率的指标。本研究旨在探讨平均 HbA1c 和 HbA1c 变异度测量值对糖尿病并发症和死亡率的预测能力。
这项回顾性观察性研究分析了 2009 年 1 月 1 日至 12 月 31 日在香港威尔士亲王医院和沙田医院门诊开处胰岛素处方的糖尿病患者。标准差（SD）、均方根（RMS）和变异系数被用作 HbA1c 变异度的测量指标。主要结局为全因和心血管死亡率。次要结局为糖尿病相关并发症。
研究队列包括 3424 名患者，其中 3137 名患者至少有三次 HbA1c 测量值。低平均 HbA1c 亚组的全因死亡率的死亡时间明显缩短（P<0.001），但心血管死亡率无显著差异（P=0.920）。高 Hba1c 亚组的全因（P<0.001）和心血管死亡率（P<0.001）的死亡时间更短。平均 Hba1c 和 Hba1c 变异性预测全因和心血管特异性死亡率。就次要结局而言，平均 HbA1c 和 HbA1c 变异性显著预测糖尿病酮症酸中毒/高渗高血糖状态/糖尿病昏迷、神经、眼科和肾脏并发症。发现二分法 HbA1c 变异性与低血糖发生频率之间存在显著相关性（P<0.0001）。
高 HbA1c 变异性与全因和心血管死亡率以及糖尿病并发症的风险增加相关。低血糖发生频率、HbA1c 变异性和死亡率之间的关联表明，间歇性低血糖会导致糖尿病患者的预后更差。
