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Diabetes Obes Metab. 2018 Aug;20(8):1885-1893. doi: 10.1111/dom.13306. Epub 2018 Apr 19.

Haemoglobin A1c variability is a strong, independent predictor of all-cause mortality in patients with type 2 diabetes.

Author information

1
Diabetes Unit, Fondazione IRCCS 'Cà Granda - Ospedale Maggiore Policlinico' and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
2
Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.
3
Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy.
4
Diabetes Unit, Azienda Ospedaliera Universitaria Senese, and Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
5
Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
6
Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy.
7
Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.
8
Department of Internal Medicine, University of Turin, Turin, Italy.
9
Department of Experimental Medicine, 'La Sapienza' University, Rome, Italy.
10
Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy.
11
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
12
Department of Clinical and Molecular Medicine, 'La Sapienza' University, Rome, Italy.

Abstract

AIMS:

To evaluate various measures of haemoglobin (Hb) A1c variability, compared with average HbA1c, as independent predictors of mortality.

MATERIALS AND METHODS:

The Renal Insufficiency And Cardiovascular Events Italian multicentre study enroled 15 733 patients with type 2 diabetes from 19 diabetes clinics during 2006-2008. A total of 3 to 5 HbA1c measures, obtained during the 2-year period before enrolment, were available from 9 centres (8290 patients) and were used to calculate average HbA1c (HbA1c -MEAN) and HbA1c variability, measured as intra-individual standard deviation (HbA1c-SD), SD adjusted for the number of HbA1c assessments (HbA1c-AdjSD) and coefficient of variation (HbA1c-CV), that is, the HbA1c-SD to HbA1c-MEAN ratio. Vital status on October 31, 2015 was retrieved for 8252 patients (99.5%).

RESULTS:

The measures of HbA1c variability increased according to quartiles of HbA1c-MEAN and vice versa. HbA1c-MEAN and measures of HbA1c variability were associated with all-cause mortality; however, the strength of association of HbA1c-MEAN was lower than that of HbA1c -SD, HbA1c-CV or HbA1c-AdjSD, and disappeared after adjusting for confounders and any of the measures of HbA1c variability. Mortality increased with quartiles of HbA1c-MEAN, HbA1c -SD, HbA1c-CV and HbA1c-AdjSD, but only the association with HbA1c variability measures remained after adjustment for confounders and/or each other measure. In the fully adjusted model, mortality risk was lower for HbA1c-SD below the median and higher for HbA1c-SD above the median, regardless of whether HbA1c-MEAN was below or above the median. Conclusions HbA1c variability is a strong, independent predictor of all-cause mortality in type 2 diabetes and appears to be even more powerful than average HbA1c in predicting mortality.

KEYWORDS:

HbA1c; all-cause mortality; cardiovascular risk factors; complications; type 2 diabetes; variability

PMID:
29582548
DOI:
10.1111/dom.13306
[Indexed for MEDLINE]

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