Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
J Clin Endocrinol Metab. 2023 Sep 18;108(10):2500-2509. doi: 10.1210/clinem/dgad203.
Glycemic variation had been demonstrated to be associated with several complications of diabetes.
Investigation of the association between visit to visit hemoglobin A1c (HbA1c) variation and the long-term risk of major adverse limb events (MALEs).
Retrospective database study. Average real variability was used to represent glycemic variations with all the HbA1c measurements during the 4 following years after the initial diagnosis of type 2 diabetes. Participants were followed from the beginning of the fifth year until death or the end of the follow-up. The association between HbA1c variations and MALEs was evaluated after adjusting for mean HbA1c and baseline characteristics. Included were 56 872 patients at the referral center with a first diagnosis of type 2 diabetes, no lower extremity arterial disease, and at least 1 HbA1c measurement in each of the 4 following years were identified from a multicenter database. The main outcome measure was incidence of a MALE, which was defined as the composite of revascularization, foot ulcers, and lower limb amputations.
The average number of HbA1c measurements was 12.6. The mean follow-up time was 6.1 years. The cumulative incidence of MALEs was 9.25 per 1000 person-years. Visit to visit HbA1c variations were significantly associated with MALEs and lower limb amputation after multivariate adjustment. People in the highest quartile of variations had increased risks for MALEs (HR 1.25, 95% CI 1.10-1.41) and lower limb amputation (HR 3.05, 95% CI 1.97-4.74).
HbA1c variation was independently associated with a long-term risk of MALEs and lower limb amputations in patients with type 2 diabetes.
血糖变异已被证明与糖尿病的几种并发症有关。
研究HbA1c（糖化血红蛋白）变异性与主要不良肢体事件（MALEs）的长期风险之间的关系。
回顾性数据库研究。使用平均真实变异来表示在 2 型糖尿病初始诊断后的 4 年内所有 HbA1c 测量值的血糖变化。参与者从第 5 年开始随访，直到死亡或随访结束。在调整平均 HbA1c 和基线特征后，评估 HbA1c 变异与 MALEs 之间的关系。从一个多中心数据库中确定了 56872 名在转诊中心首次诊断为 2 型糖尿病、无下肢动脉疾病且在接下来的 4 年中至少有 1 次 HbA1c 测量值的患者。主要观察指标是 MALEs 的发生率，MALEs 定义为血运重建、足部溃疡和下肢截肢的复合事件。
平均 HbA1c 测量次数为 12.6 次。平均随访时间为 6.1 年。MALEs 的累积发生率为每 1000 人年 9.25 例。在多变量调整后，HbA1c 变异性与 MALEs 和下肢截肢显著相关。变异最高四分位的患者发生 MALEs 的风险增加（HR 1.25，95%CI 1.10-1.41）和下肢截肢（HR 3.05，95%CI 1.97-4.74）。
HbA1c 变异与 2 型糖尿病患者 MALEs 和下肢截肢的长期风险独立相关。
