Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study
Joshua Kuan Tan,1 Gek Hsiang Lim,1 Nur Nasyitah Mohamed Salim,1 Sing Yi Chia,1 Julian Thumboo,1 Yong Mong Bee2 1Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore; 2Department of Endocrinology, Singapore General Hospital, Singapore, 169608, SingaporeCorrespondenc...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-01-01
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| Series: | Clinical Epidemiology |
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| Online Access: | https://www.dovepress.com/associations-between-mean-hba1c-hba1c-variability-and-both-mortality-a-peer-reviewed-fulltext-article-CLEP |
| _version_ | 1811168865116225536 |
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| author | Tan JK Lim GH Mohamed Salim NN Chia SY Thumboo J Bee YM |
| author_facet | Tan JK Lim GH Mohamed Salim NN Chia SY Thumboo J Bee YM |
| author_sort | Tan JK |
| collection | DOAJ |
| description | Joshua Kuan Tan,1 Gek Hsiang Lim,1 Nur Nasyitah Mohamed Salim,1 Sing Yi Chia,1 Julian Thumboo,1 Yong Mong Bee2 1Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore; 2Department of Endocrinology, Singapore General Hospital, Singapore, 169608, SingaporeCorrespondence: Yong Mong Bee, Department of Endocrinology, Singapore General Hospital, Singapore, 169608, Singapore, Tel +65 6321 3753, Email bee.yong.mong@singhealth.com.sgBackground: We investigate the association between mean HbA1c, HbA1c variability, and all-cause mortality and diabetes-related macrovascular complications in patients with diabetes.Methods: We performed a retrospective cohort study using patients present in the Singapore Health Services diabetes registry (SDR) during 2013 to 2014. We assessed mean HbA1c using three models: a baseline mean HbA1c for 2013– 14, the mean across the whole follow-up period, and a time-varying yearly updated mean. We assessed HbA1c variability at baseline using the patient’s HbA1c variability score (HVS) for 2013– 14. The association between mean HbA1c, HVS, and 6 outcomes were assessed using Cox proportional hazard models.Results: We included 43,837– 53,934 individuals in the analysis; 99.3% had type 2 diabetes mellitus. The data showed a J-shaped distribution in adjusted hazard ratios (HRs) for all-cause mortality, ischemic heart disease, acute myocardial infarction, peripheral arterial disease, and ischemic stroke, with an increased risk of developing these outcomes at HbA1c < 6% (42 mmol/mol) and ≥ 8% (64 mmol/mol). With the addition of HVS, the J-shaped distribution was maintained for the above outcomes, but HRs were greater at HbA1c < 6.0% (42 mmol/mol) and reduced at HbA1c ≥ 8.0% (64 mmol/mol) when compared to models without HVS. The risk for all outcomes increased substantially with increasing glycaemic variability.Conclusion: Both low (< 6.0% [42 mmol/mol]) and high (≥ 8.0% [64 mmol/mol]) levels of glycaemic control are associated with increased all-cause mortality and diabetes-related macrovascular complications. Glycaemic variability is independently associated with increased risk for these outcomes. Therefore, patients with stable glycaemic level of 6– 8% (42– 64mmol/mol) are at lowest risk of all-cause mortality and diabetes-related macrovascular complications.Keywords: diabetes mellitus, diabetes mellitus complications, glycated haemoglobin, glycated haemoglobin analysis, cardiovascular diseases |
| first_indexed | 2024-04-10T16:32:31Z |
| format | Article |
| id | doaj.art-81613e6beba944c8a67951745f5e7772 |
| institution | Directory Open Access Journal |
| issn | 1179-1349 |
| language | English |
| last_indexed | 2024-04-10T16:32:31Z |
| publishDate | 2023-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical Epidemiology |
| spelling | doaj.art-81613e6beba944c8a67951745f5e77722023-02-08T22:12:28ZengDove Medical PressClinical Epidemiology1179-13492023-01-01Volume 1513714981248Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort StudyTan JKLim GHMohamed Salim NNChia SYThumboo JBee YMJoshua Kuan Tan,1 Gek Hsiang Lim,1 Nur Nasyitah Mohamed Salim,1 Sing Yi Chia,1 Julian Thumboo,1 Yong Mong Bee2 1Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore; 2Department of Endocrinology, Singapore General Hospital, Singapore, 169608, SingaporeCorrespondence: Yong Mong Bee, Department of Endocrinology, Singapore General Hospital, Singapore, 169608, Singapore, Tel +65 6321 3753, Email bee.yong.mong@singhealth.com.sgBackground: We investigate the association between mean HbA1c, HbA1c variability, and all-cause mortality and diabetes-related macrovascular complications in patients with diabetes.Methods: We performed a retrospective cohort study using patients present in the Singapore Health Services diabetes registry (SDR) during 2013 to 2014. We assessed mean HbA1c using three models: a baseline mean HbA1c for 2013– 14, the mean across the whole follow-up period, and a time-varying yearly updated mean. We assessed HbA1c variability at baseline using the patient’s HbA1c variability score (HVS) for 2013– 14. The association between mean HbA1c, HVS, and 6 outcomes were assessed using Cox proportional hazard models.Results: We included 43,837– 53,934 individuals in the analysis; 99.3% had type 2 diabetes mellitus. The data showed a J-shaped distribution in adjusted hazard ratios (HRs) for all-cause mortality, ischemic heart disease, acute myocardial infarction, peripheral arterial disease, and ischemic stroke, with an increased risk of developing these outcomes at HbA1c < 6% (42 mmol/mol) and ≥ 8% (64 mmol/mol). With the addition of HVS, the J-shaped distribution was maintained for the above outcomes, but HRs were greater at HbA1c < 6.0% (42 mmol/mol) and reduced at HbA1c ≥ 8.0% (64 mmol/mol) when compared to models without HVS. The risk for all outcomes increased substantially with increasing glycaemic variability.Conclusion: Both low (< 6.0% [42 mmol/mol]) and high (≥ 8.0% [64 mmol/mol]) levels of glycaemic control are associated with increased all-cause mortality and diabetes-related macrovascular complications. Glycaemic variability is independently associated with increased risk for these outcomes. Therefore, patients with stable glycaemic level of 6– 8% (42– 64mmol/mol) are at lowest risk of all-cause mortality and diabetes-related macrovascular complications.Keywords: diabetes mellitus, diabetes mellitus complications, glycated haemoglobin, glycated haemoglobin analysis, cardiovascular diseaseshttps://www.dovepress.com/associations-between-mean-hba1c-hba1c-variability-and-both-mortality-a-peer-reviewed-fulltext-article-CLEPdiabetes mellitusdiabetes mellitus complicationsglycated haemoglobinglycated haemoglobin analysiscardiovascular diseases |
| spellingShingle | Tan JK Lim GH Mohamed Salim NN Chia SY Thumboo J Bee YM Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study Clinical Epidemiology diabetes mellitus diabetes mellitus complications glycated haemoglobin glycated haemoglobin analysis cardiovascular diseases |
| title | Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study |
| title_full | Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study |
| title_fullStr | Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study |
| title_full_unstemmed | Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study |
| title_short | Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study |
| title_sort | associations between mean hba1c hba1c variability and both mortality and macrovascular complications in patients with diabetes mellitus a registry based cohort study |
| topic | diabetes mellitus diabetes mellitus complications glycated haemoglobin glycated haemoglobin analysis cardiovascular diseases |
| url | https://www.dovepress.com/associations-between-mean-hba1c-hba1c-variability-and-both-mortality-a-peer-reviewed-fulltext-article-CLEP |
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