Shen Yun, Zhou Jian, Shi Lizheng, Nauman Elizabeth, Katzmarzyk Peter T, Price-Haywood Eboni G, Horswell Ronald, Bazzano Alessandra N, Nigam Somesh, Hu Gang
Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Diabetes Obes Metab. 2021 Jan;23(1):125-135. doi: 10.1111/dom.14201. Epub 2020 Oct 7.
To investigate the association between visit-to-visit HbA1c variability and the risk of cardiovascular disease in patients with type 2 diabetes.
We performed a retrospective cohort study of 29 260 patients with at least four HbA1c measurements obtained within 2 years of their first diagnosis of type 2 diabetes. Different HbA1c variability markers were calculated, including the standard deviation (SD), coefficient of variation (CV) and adjusted SD. Cox proportional hazards regression models were used to estimate the association of these HbA1c variability markers with incident cardiovascular disease.
During a mean follow-up of 4.18 years, a total of 3746 incident cardiovascular disease cases were diagnosed. Multivariate-adjusted hazard ratios for cardiovascular disease across the first, second, third and fourth quartiles of HbA1c SD values were 1.00, 1.30 (95% confidence interval [CI] 1.18-1.42), 1.40 (95% CI 1.26-1.55) and 1.59 (95% CI 1.41-1.77) (P for trend <.001), respectively. When we utilized HbA1c CV and adjusted HbA1c SD values as exposures, similar positive associations were observed. HbA1c variability was also associated with the risk of first and recurrent severe hypoglycaemic events. A mediating effect of severe hypoglycaemia was observed between HbA1c variability and incident cardiovascular disease.
Large visit-to-visit HbA1c variability is associated with an increased risk of cardiovascular disease in patients with type 2 diabetes. Severe hypoglycaemia may mediate the association between HbA1c variability and incident cardiovascular disease.
探讨2型糖尿病患者就诊间糖化血红蛋白（HbA1c）变异性与心血管疾病风险之间的关联。
我们对29260例2型糖尿病初诊后2年内至少进行过4次HbA1c测量的患者进行了一项回顾性队列研究。计算了不同的HbA1c变异性指标，包括标准差（SD）、变异系数（CV）和校正标准差。采用Cox比例风险回归模型估计这些HbA1c变异性指标与心血管疾病发生之间的关联。
在平均4.18年的随访期间，共诊断出3746例心血管疾病病例。HbA1c SD值第一、二、三、四分位数对应的心血管疾病多因素校正风险比分别为1.00、1.30（95%置信区间[CI]1.18 - 1.42）、1.40（95%CI 1.26 - 1.55）和1.59（95%CI 1.41 - 1.77）（趋势P <.001）。当我们将HbA1c CV和校正后的HbA1c SD值作为暴露因素时，观察到了类似的正相关关系。HbA1c变异性还与首次及反复发生的严重低血糖事件风险相关。在HbA1c变异性与心血管疾病发生之间观察到严重低血糖的中介作用。
2型糖尿病患者就诊间HbA1c变异性大与心血管疾病风险增加相关。严重低血糖可能介导了HbA1c变异性与心血管疾病发生之间的关联。
