Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Faculty of Medicine, Center for Clinical Epidemiology and Clinical Statistics, Chiang Mai University, Chiang Mai, Thailand.
J Diabetes Investig. 2023 Dec;14(12):1391-1400. doi: 10.1111/jdi.14073. Epub 2023 Aug 23.
AIMS/INTRODUCTION: High glycated hemoglobin (HbA1c) variability has been reported to be linked with cardiovascular events in type 2 diabetes patients. Only a few studies have been carried out on Asian patients. This study aimed to investigate the association of prediabetes and type 2 diabetes in Asian patients by performing a post-hoc analysis of a multicenter, prospective, observational study.
Data for prediabetes and type 2 diabetes patients were retrieved from a multicenter national registry entitled "CORE-Thailand study." The primary outcome was 4P-MACE (major adverse cardiovascular events, including non-fatal myocardial infarction, heart failure hospitalization, non-fatal stroke and all-cause death). Patients were stratified according to quartiles of HbA1c standard deviation. The Cox proportional hazards regression model was used to estimate the association of HbA1c variability with incident cardiovascular disease.
A total of 3,811 patients with prediabetes and type 2 diabetes were included. The median follow-up duration was 54 months. In the fully adjusted model, the highest quartile of HbA1c variability showed a statistically significant association with 4P-MACE (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.77-4.35), fatal and non-fatal myocardial infarction (HR 6.91, 95% CI 1.90-25.12), hospitalization for heart failure (HR 3.34, 95% CI 1.20-9.26) and all-cause death (HR 3.10, 95% CI 1.72-5.57). All these outcomes were statistically significantly different among four quartiles of HbA1c (log-rank P-value <0.05). Fatal and non-fatal stroke showed no statistically significant association with high HbA1c variability.
High HbA1c variability in the highest quartile showed a statistically significant association with multiple adverse cardiovascular events in an Asian population. Minimizing HbA1c fluctuation during long-term follow up should be another important objective for type 2 diabetes patients.
目的/引言：糖化血红蛋白（HbA1c）变异性高与 2 型糖尿病患者的心血管事件有关。仅有少数研究针对亚洲患者进行。本研究旨在通过对一项多中心、前瞻性、观察性研究进行事后分析，调查亚洲患者的糖尿病前期和 2 型糖尿病之间的关联。
从一个名为“CORE-Thailand 研究”的多中心国家注册处检索糖尿病前期和 2 型糖尿病患者的数据。主要结局为 4P-MACE（主要不良心血管事件，包括非致死性心肌梗死、心力衰竭住院、非致死性卒中和全因死亡）。根据 HbA1c 标准差的四分位数对患者进行分层。使用 Cox 比例风险回归模型估计 HbA1c 变异性与心血管疾病事件发生的关联。
共纳入 3811 例糖尿病前期和 2 型糖尿病患者。中位随访时间为 54 个月。在完全调整的模型中，HbA1c 变异性最高四分位数与 4P-MACE（风险比 [HR] 2.77，95%置信区间 [CI] 1.77-4.35）、致死性和非致死性心肌梗死（HR 6.91，95%CI 1.90-25.12）、心力衰竭住院（HR 3.34，95%CI 1.20-9.26）和全因死亡（HR 3.10，95%CI 1.72-5.57）显著相关。在 HbA1c 四分位数的四个四分位数之间，所有这些结果均具有统计学差异（对数秩 P 值<0.05）。致命性和非致命性卒中与 HbA1c 变异性高无统计学显著关联。
在亚洲人群中，HbA1c 最高四分位的高变异性与多种不良心血管事件具有统计学显著关联。在长期随访期间尽量减少 HbA1c 波动应成为 2 型糖尿病患者的另一个重要目标。
