Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Diabetes Res Clin Pract. 2022 Oct;192:110069. doi: 10.1016/j.diabres.2022.110069. Epub 2022 Sep 5.
To study the different effects of mean HbA1c and HbA1c variability on diabetes-related complications in patients with type 2 diabetes mellitus.
1869 patients with type 2 diabetes were followed-up for a median of 9.5 years in a Diabetes Shared Care Program. Mean HbA1c (HbA1c-mean) and standard deviation of HbA1c (HbA1c-SD) were calculated during the first 5 years. The clinical outcomes included nephropathy (urine albumin-to-creatinine ratio [UACR] > 300 mg/g and doubling of serum creatinine), retinopathy (any and advanced), and mortality (due to all-causes, and cardiovascular disease [CVD]).
HbA1c-mean was independently associated with UACR > 300 mg/g (Hazard ratio [HR] 1.308 [95% confidence interval {CI}, 1.194-1.433]), any retinopathy (HR 1.274 [1.171-1.385]), and advanced retinopathy (HR 1.237 [1.014-1.509]). HbA1c-SD was independently associated with UACR > 300 mg/g (HR 1.478 [1.189-1.837]), doubling of serum creatinine (HR 2.133 [1.470-3.095]), all-cause mortality (HR 1.880 [1.561-2.266]), and CVD mortality (HR 1.431 [1.069-1.915]). Receiver operating characteristic (ROC) curves showed HbA1c-mean was more associated with any retinopathy, whereas HbA1c-SD was more associated with doubling of serum creatinine, all-cause and CVD mortality.
Both HbA1c-mean and HbA1c-SD predicted most diabetes-related complications in patients with type 2 diabetes. However, HbA1c-mean was more effective at predicting retinopathy, while HbA1c-SD was more effective at predicting deterioration of renal function and increased mortality.
研究糖化血红蛋白（HbA1c）均值和 HbA1c 变异性对 2 型糖尿病患者相关并发症的不同影响。
1869 例 2 型糖尿病患者在糖尿病共病管理项目中接受了中位时间为 9.5 年的随访。在最初的 5 年内计算 HbA1c 均值（HbA1c-mean）和 HbA1c 标准差（HbA1c-SD）。临床结局包括肾病（尿白蛋白/肌酐比值[UACR]＞300mg/g 和血清肌酐加倍）、视网膜病变（任意和晚期）和死亡率（全因和心血管疾病[CVD]）。
HbA1c-mean 与 UACR＞300mg/g（风险比[HR]1.308[95%置信区间{CI}，1.194-1.433]）、任何视网膜病变（HR 1.274[1.171-1.385]）和晚期视网膜病变（HR 1.237[1.014-1.509]）独立相关。HbA1c-SD 与 UACR＞300mg/g（HR 1.478[1.189-1.837]）、血清肌酐加倍（HR 2.133[1.470-3.095]）、全因死亡率（HR 1.880[1.561-2.266]）和 CVD 死亡率（HR 1.431[1.069-1.915]）独立相关。受试者工作特征（ROC）曲线显示，HbA1c-mean 与任何视网膜病变的相关性更高，而 HbA1c-SD 与血清肌酐加倍、全因和 CVD 死亡率的相关性更高。
HbA1c-mean 和 HbA1c-SD 均预测了 2 型糖尿病患者的大多数相关并发症。然而，HbA1c-mean 对预测视网膜病变更有效，而 HbA1c-SD 对预测肾功能恶化和死亡率增加更有效。
