Huang Lihua, He Liuliu, Luo Xiaoyan, Zhou Xiaoqing
Department of Clinical Laboratory, The Second Affiliated Hospital of Gannan Medical University, Ganzhou, China.
Department of Interventional Radiology, The Second Affiliated Hospital of Gannan Medical University, Ganzhou, China.
Diabetol Metab Syndr. 2024 Sep 11;16(1):221. doi: 10.1186/s13098-024-01462-1.
While the high haemoglobin glycation index (HGI) has been extensively investigated in diabetic populations, its impact on patients with diabetic kidney disease (DKD) remains unclear.
We examined data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 1999 and 2018. HGI was determined using the formula recommended by Hempe et al., which calculates the difference between measured and predicted HbA1c. Predicted HbA1c was derived from the equation: 0.024 FPG + 3.1. National death index records up to December 31, 2019, were utilized to assess mortality outcomes. To estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for both all-cause and cardiovascular disease (CVD) mortality, we utilized Cox proportional hazard models. A restricted cubic spline analysis was performed to explore the potential nonlinear relationship between HGI levels and mortality.
Our cohort study comprised data from 1,057 participants with DKD (mean [SE] age, 61.61 [0.57] years; 48.24% female). The mean HGI level was 0.44 (SE 0.04). Over a median follow-up period of 6.67 years, we observed 381 deaths, including 140 due to CVD. Compared with participants in the second tertile of HGI levels (0.03-0.74), those in the lowest tertile of HGI (-5.29-0.02) exhibited an all-cause mortality hazard ratio of 1.39 (95% CI, 1.02-1.88) and a CVD mortality hazard ratio of 1.10 (95% CI, 0.67-1.81). Conversely, participants in the highest tertile (0.75-9.60) demonstrated an all-cause mortality hazard ratio of 1.48 (95% CI, 1.05-2.08) and a CVD mortality hazard ratio of 2.06 (95% CI, 1.13-3.77) after further adjusting for HbA1c and other important variables. Additionally, a restricted cubic spline analysis revealed a U-shaped relationship between HGI and all-cause mortality (P < 0.001 for nonlinearity) and a J-shaped relationship between HGI and CVD mortality (P = 0.044 for nonlinearity).
Our cohort study suggests that HGI in DKD populations exhibits a U-shaped association with all-cause mortality and a J-shaped association with CVD mortality, independent of HbA1c levels.
虽然高血红蛋白糖化指数（HGI）在糖尿病患者中已得到广泛研究，但其对糖尿病肾病（DKD）患者的影响仍不清楚。
我们检查了1999年至2018年期间进行的美国国家健康与营养检查调查（NHANES）的数据。HGI使用Hempe等人推荐的公式确定，该公式计算测量的糖化血红蛋白（HbA1c）与预测的HbA1c之间的差异。预测的HbA1c由以下公式得出：0.024×空腹血糖（FPG）+3.1。利用截至2019年12月31日的国家死亡指数记录来评估死亡结局。为了估计全因死亡率和心血管疾病（CVD）死亡率的风险比（HRs）及95%置信区间（CIs），我们使用了Cox比例风险模型。进行了限制立方样条分析以探索HGI水平与死亡率之间潜在的非线性关系。
我们的队列研究纳入了1057名DKD患者的数据（平均[标准误]年龄为61.61[0.57]岁；48.24%为女性）。平均HGI水平为0.44（标准误0.04）。在中位随访期6.67年期间，我们观察到381例死亡，其中140例死于CVD。与HGI水平处于第二个三分位数（0.03 - 0.74）的参与者相比，HGI处于最低三分位数（-5.29 - 0.02）的参与者全因死亡率风险比为1.39（95%CI，1.02 - 1.88），CVD死亡率风险比为1.10（95%CI，0.67 - 1.81）。相反，在进一步调整HbA1c和其他重要变量后，HGI处于最高三分位数（0.75 - 9.60）的参与者全因死亡率风险比为1.48（95%CI，1.05 - 2.08），CVD死亡率风险比为2.06（95%CI，1.13 - 3.77）。此外，限制立方样条分析显示HGI与全因死亡率之间呈U形关系（非线性P<0.001），HGI与CVD死亡率之间呈J形关系（非线性P = 0.044）。
我们的队列研究表明，DKD人群中的HGI与全因死亡率呈U形关联，与CVD死亡率呈J形关联，且独立于HbA1c水平。
