Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Endocrinol Metab (Seoul). 2024 Oct;39(5):732-747. doi: 10.3803/EnM.2024.2001. Epub 2024 Oct 15.
This study investigated the prognostic importance of the hemoglobin glycation index (HGI) for macrovascular and microvascular outcomes, mortality, and hypoglycemia occurrence in a type 2 diabetes cohort and compared it to glycated hemoglobin (HbA1c).
Baseline and mean first-year HGI and HbA1c, and the variability thereof, were assessed in 687 individuals with type 2 diabetes (median follow-up, 10.6 years). Multivariable Cox regression was conducted to evaluate the associations of HGI and HbA1c parameters with macrovascular (total and major cardiovascular events) and microvascular outcomes (microalbuminuria, advanced renal failure, retinopathy, and peripheral neuropathy), mortality (all-cause and cardiovascular), and moderate/severe hypoglycemia occurrence.
During follow-up, there were 215 total cardiovascular events (176 major) and 269 all-cause deaths (131 cardiovascular). Microalbuminuria developed in 126 patients, renal failure in 104, retinopathy in 161, and neuropathy in 177. There were 90 hypoglycemia episodes. Both HGI and HbA1c predicted all adverse outcomes, except microalbuminuria and hypoglycemia. Their adjusted risks were roughly equivalent for all outcomes. For example, the adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), estimated for 1 standard deviation increments, of mean first-year HGI were 1.23 (1.05 to 1.44), 1.20 (1.03 to 1.38), 1.36 (1.11 to 1.67), 1.28 (1.09 to 1.67), and 1.29 (1.09 to 1.54), respectively, for cardiovascular events, all-cause mortality, renal failure, retinopathy, and neuropathy; whereas the respective HRs (95% CIs) of mean HbA1c were 1.31 (1.12 to 1.53), 1.28 (1.11 to 1.48), 1.36 (1.11 to 1.67), 1.33 (1.14 to 1.55), and 1.29 (1.09 to 1.53).
HGI was no better than HbA1c as a predictor of adverse outcomes in individuals with type 2 diabetes, and its clinical use cannot be currently advised.
本研究旨在探讨血红蛋白糖化指数（HGI）对 2 型糖尿病患者大血管和微血管结局、死亡率和低血糖发生的预后意义，并将其与糖化血红蛋白（HbA1c）进行比较。
在 687 例 2 型糖尿病患者（中位随访时间 10.6 年）中，评估了基线和第一年的平均 HGI 和 HbA1c 及其变异性。采用多变量 Cox 回归评估 HGI 和 HbA1c 参数与大血管（总心血管事件和主要心血管事件）和微血管结局（微量白蛋白尿、进展性肾衰竭、视网膜病变和周围神经病变）、死亡率（全因和心血管原因）和中度/重度低血糖发生的关系。
随访期间共发生 215 例全因心血管事件（176 例主要心血管事件）和 269 例全因死亡（131 例心血管原因）。126 例患者发生微量白蛋白尿，104 例发生肾衰竭，161 例发生视网膜病变，177 例发生神经病变。发生 90 例低血糖事件。HGI 和 HbA1c 均预测所有不良结局，但不包括微量白蛋白尿和低血糖。它们的调整风险对于所有结局大致相当。例如，估计平均第一年 HGI 每增加 1 个标准差的调整后风险比（HR）及其 95%置信区间（CI）分别为 1.23（1.05 至 1.44）、1.20（1.03 至 1.38）、1.36（1.11 至 1.67）、1.28（1.09 至 1.67）和 1.29（1.09 至 1.54），分别用于心血管事件、全因死亡率、肾衰竭、视网膜病变和神经病变；而平均 HbA1c 的相应 HR（95%CI）分别为 1.31（1.12 至 1.53）、1.28（1.11 至 1.48）、1.36（1.11 至 1.67）、1.33（1.14 至 1.55）和 1.29（1.09 至 1.53）。
HGI 作为 2 型糖尿病患者不良结局的预测指标并不优于 HbA1c，目前不能建议其临床应用。
