Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan; Department of Medicine, China Medical University, Taichung 40402, Taiwan.
Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan.
Prim Care Diabetes. 2024 Apr;18(2):146-150. doi: 10.1016/j.pcd.2024.01.014. Epub 2024 Feb 2.
Glycated hemoglobin A1c (HbA1c) variation or blood pressure (BP) variation was known to be an independent predictor of all-cause mortality in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the combined effect of HbA1c and systolic blood pressure (SBP) variation on all-cause mortality and if there was a gender difference in patients with T2DM.
Patients with T2DM who had at least three HbA1c, SBP measurements within 12-24 months during 2001-2007 were included. Coefficient of variation (CV) was used to evaluate variation. The 75th percentile of HbA1c-CV and SBP-CV were set as a cutoff to define high and low variation. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazard models.
A total of 2744 patients were included, of whom 769 died during the 11.7 observation years. The associated risk of all-cause mortality was 1.22 [1.01- 1.48], P = 0.044, for low HbA1c-CV & high SBP-CV; 1.28 [1.04-1.57], P = 0.020, for high HbA1c-CV & low SBP-CV; and 1.68 [1.31-2.17], P < 0.001, for high HbA1c-CV & high SBP-CV. The associated risk remained unchanged in either males or females older than 50 years old, although there is only numerically higher for high HbA1c-CV & low SBP-CV in females older than 50 years old.
Both HbA1c and SBP variation were significant predictors of all-cause mortality in patients with T2DM. The combined effect was higher than either alone and no gender difference in patients older than 50 years old.
糖化血红蛋白 A1c（HbA1c）变异或血压（BP）变异已知是 2 型糖尿病（T2DM）患者全因死亡率的独立预测因素。本研究旨在探讨 HbA1c 和收缩压（SBP）变异对全因死亡率的综合影响，以及 T2DM 患者是否存在性别差异。
纳入 2001-2007 年内至少有 3 次 HbA1c、SBP 测量值的 T2DM 患者。变异系数（CV）用于评估变异。将 HbA1c-CV 和 SBP-CV 的第 75 百分位数设定为截断值，以定义高变异和低变异。使用 Cox 比例风险模型估计风险比（HRs）和 95%置信区间。
共纳入 2744 例患者，其中 769 例在 11.7 年的观察期间死亡。低 HbA1c-CV 和高 SBP-CV 的全因死亡相关风险为 1.22[1.01-1.48]，P=0.044；高 HbA1c-CV 和低 SBP-CV 的风险为 1.28[1.04-1.57]，P=0.020；高 HbA1c-CV 和高 SBP-CV 的风险为 1.68[1.31-2.17]，P<0.001。在年龄大于 50 岁的男性或女性中，相关性风险保持不变，尽管在年龄大于 50 岁的女性中，高 HbA1c-CV 和低 SBP-CV 的风险略高。
HbA1c 和 SBP 变异均是 T2DM 患者全因死亡率的重要预测因素。联合效应高于单一因素，且在年龄大于 50 岁的患者中无性别差异。
