Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China.
School of Data Science, City University of Hong Kong, Hong Kong, China.
BMC Endocr Disord. 2021 May 4;21(1):94. doi: 10.1186/s12902-021-00751-4.
Recent studies have reported that HbA1c and lipid variability is useful for risk stratification in diabetes mellitus. The present study evaluated the predictive value of the baseline, subsequent mean of at least three measurements and variability of HbA1c and lipids for adverse outcomes.
This retrospective cohort study consists of type 1 and type 2 diabetic patients who were prescribed insulin at outpatient clinics of Hong Kong public hospitals, from 1st January to 31st December 2009. Standard deviation (SD) and coefficient of variation were used to measure the variability of HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride. The primary outcome is all-cause mortality. Secondary outcomes were diabetes-related complications.
The study consists of 25,186 patients (mean age = 63.0, interquartile range [IQR] of age = 15.1 years, male = 50%). HbA1c and lipid value and variability were significant predictors of all-cause mortality. Higher HbA1c and lipid variability measures were associated with increased risks of neurological, ophthalmological and renal complications, as well as incident dementia, osteoporosis, peripheral vascular disease, ischemic heart disease, atrial fibrillation and heart failure (p < 0.05). Significant association was found between hypoglycemic frequency (p < 0.0001), HbA1c (p < 0.0001) and lipid variability against baseline neutrophil-lymphocyte ratio (NLR).
Raised variability in HbA1c and lipid parameters are associated with an elevated risk in both diabetic complications and all-cause mortality. The association between hypoglycemic frequency, baseline NLR, and both HbA1c and lipid variability implicate a role for inflammation in mediating adverse outcomes in diabetes, but this should be explored further in future studies.
最近的研究报告称，HbA1c 和血脂变异性可用于糖尿病的风险分层。本研究评估了基线、至少三次测量的后续平均值和 HbA1c 及血脂变异性对不良结局的预测价值。
本回顾性队列研究纳入了 2009 年 1 月 1 日至 12 月 31 日期间在香港公立医院门诊开处胰岛素的 1 型和 2 型糖尿病患者。标准差（SD）和变异系数用于测量 HbA1c、总胆固醇、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯的变异性。主要结局是全因死亡率。次要结局是糖尿病相关并发症。
本研究共纳入 25186 例患者（平均年龄 63.0 岁，年龄的四分位距[IQR]为 15.1 岁，男性占 50%）。HbA1c 和血脂值及其变异性是全因死亡率的显著预测因素。较高的 HbA1c 和血脂变异性指标与神经、眼科和肾脏并发症风险增加以及痴呆、骨质疏松症、外周血管疾病、缺血性心脏病、心房颤动和心力衰竭（p<0.05）的发生率增加相关。低血糖发生频率（p<0.0001）、HbA1c（p<0.0001）与血脂变异性均与基线中性粒细胞-淋巴细胞比值（NLR）显著相关。
HbA1c 和血脂参数的变异性增加与糖尿病并发症和全因死亡率风险增加相关。低血糖发生频率、基线 NLR 以及 HbA1c 和血脂变异性之间的相关性提示炎症在介导糖尿病不良结局方面发挥作用，但这需要在未来的研究中进一步探讨。
