Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Department of Family Medicine, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
Diabetes Obes Metab. 2024 Nov;26(11):5138-5146. doi: 10.1111/dom.15856. Epub 2024 Aug 19.
To evaluate the association between changes in haemoglobin A1c (HbA1c) and the concurrent incidence of cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM) patients.
We conducted a retrospective cohort study among T2DM patients with HbA1c measurement after T2DM diagnosis between August 2009 and September 2010. The patients were classified into six subgroups based on baseline HbA1c (<7%; 7%-7.9%; ≥8%) and age (<65; ≥65 years), and then clustered into classes by HbA1c trajectory and CVD incidence over the 12-year follow-up period using joint latent class mixture models. We explored the HbA1c trajectories and CVD incidences in each latent class. Multinomial logistic regression was used to compare the baseline characteristics among different latent classes.
A total of 128 843 T2DM patients were included with a median follow-up period of 11.7 years. Ten latent classes were identified in patients with baseline HbA1c ≥ 8% and age <65 years, while seven classes were identified in the other five groups. Among all the identified latent classes, patients with fluctuating HbA1c trajectories, characterized by alternating periods of increase and decrease, had higher CVD incidences. Male patients, and patients with higher baseline HbA1c and use of antidiabetic drugs were more likely to have a fluctuating HbA1c trajectory. More specifically, patients aged < 65 years with younger age or a smoking habit, and patients aged ≥ 65 years with a longer duration of T2DM were more likely to have a fluctuating HbA1c trajectory.
We found that T2DM patients with fluctuating HbA1c trajectories could have a higher CVD risk. Different trajectory-associated characteristics in age subgroups highlight the need for individualized management of T2DM patients.
评估糖化血红蛋白（HbA1c）变化与 2 型糖尿病（T2DM）患者并发心血管疾病（CVD）的相关性。
我们对 2009 年 8 月至 2010 年 9 月间 T2DM 诊断后进行 HbA1c 检测的 T2DM 患者进行了回顾性队列研究。根据基线 HbA1c（<7%；7%-7.9%；≥8%）和年龄（<65；≥65 岁），将患者分为 6 个亚组，然后使用联合潜在类别混合模型，根据 12 年随访期间的 HbA1c 轨迹和 CVD 发生率对患者进行聚类分组。我们探讨了每个潜在类别中的 HbA1c 轨迹和 CVD 发生率。采用多项逻辑回归比较不同潜在类别间的基线特征。
共纳入 128843 例 T2DM 患者，中位随访时间为 11.7 年。在基线 HbA1c≥8%且年龄<65 岁的患者中确定了 10 个潜在类别，而在其他 5 个组中确定了 7 个类别。在所有确定的潜在类别中，HbA1c 轨迹波动的患者（表现为增加和减少交替的阶段）发生 CVD 的风险更高。男性患者、基线 HbA1c 较高和使用降糖药物的患者更有可能出现 HbA1c 轨迹波动。具体而言，年龄<65 岁的患者，年龄较小或有吸烟习惯，年龄≥65 岁的患者，T2DM 病程较长，更有可能出现 HbA1c 轨迹波动。
我们发现 HbA1c 轨迹波动的 T2DM 患者可能具有更高的 CVD 风险。年龄亚组中不同轨迹相关特征表明，需要对 T2DM 患者进行个体化管理。
