Variability in hemoglobin A1c predicts all-cause mortality in patients with type 2 diabetes
Variability in hemoglobin A1c predicts all-cause mortality in patients with type 2 diabetes
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DOI：
10.1016/j.jdiacomp.2012.03.028
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发表时间：
2012-07-01
影响因子：
3
通讯作者：
Su, Ching-Chieh
中科院分区：
文献类型：
--
作者：
Ma, Wen-Ya;Li, Hung-Yuan;Su, Ching-Chieh
背景资料：为了评估血红蛋白A1 c变异性与2型糖尿病患者全因死亡率之间的关系，方法：这是一项回顾性队列研究，在2003年至2009年期间随访至少2年的2型糖尿病患者。根据系列A1 C值的标准差或变异系数（A1 C（SD）或A1 C（CV））确定A1 C变异性。根据A1 C（CV）中位数，将受试者分为高A1 C变异性组或低A1 C变异性组。从考克斯的比例风险models.Results：确定了各种因素的全因死亡率的风险比（HR）：共881例（422名男性，459名女性），73（8.3%）在随访期间死亡。随访期为4.7 +/- 2.3年。高A1 C（CV）受试者的全因死亡率较高（11.0% vs. 5.4%，p = 0.002）。在Kaplan-Meier失败曲线中，A1 C（CV）较高的受试者表现出死亡率较高的趋势（p = 0.1）。在多变量考克斯比例风险模型中，A1 C（SD）和A1 C（CV）显著预测全因死亡率，HR为1.987（p = 0.02）和1.062（p = 0.013），分别在调整年龄、性别、体重指数、糖尿病病程、平均收缩压、抗高血压药和他汀类药物的使用、平均LDL胆固醇、吸烟状况、慢性肾脏疾病和平均A1 C值（A1 C（MEAN））。A1 C（SD）和A1 C（CV）预测全因死亡率的能力在A1 C（MEAN）相对较低的受试者中更为明显。结论：A1 C变异性是2型糖尿病患者全因死亡的重要危险因素。(C)2012 Elsevier Inc. All rights reserved.
Background: To evaluate the relationship between hemoglobin A1c variability and all-cause mortality in type 2 diabetic patients.Methods: This was a retrospective cohort study in type 2 diabetic patients followed for at least 2 years between 2003 and 2009. A1C variability was determined from the standard deviation or coefficient of variation of serial A1C values (A1C(SD) or A1C(CV)). Subjects were categorized into either the high or low A1C variability group according to their A1C(CV) median. Hazard ratios (HRs) of various factors for all-cause mortality were determined from Cox's proportional hazard models.Results: A total of 881 subjects (422 men, 459 women) were included and 73 (8.3%) died during follow-up. The follow-up period was 4.7 +/- 2.3 years. All-cause mortality was higher in subjects with high A1C(CV) (11.0% vs. 5.4%, p = 0.002). In the Kaplan-Meier failure curve, subjects with higher A1C(CV) demonstrated a trend of higher mortality (p = 0.1). In multivariate Cox's proportional hazards models, A1C(SD) and A1C(CV) significantly predicted all-cause mortality with an HR of 1.987 (p = 0.02) and 1.062 (p = 0.013), respectively, after adjusting for age, gender, body mass index, duration of diabetes, mean systolic blood pressure, use of antihypertensives and statins, mean LDL-cholesterol, smoking status, chronic kidney disease, and mean A1C values (A1C(MEAN)). The ability of A1C(SD) and A1C(CV) to predict all-cause mortality was more evident in subjects with relatively low A1C(MEAN).Conclusions: A1C variability is an important risk factor for all-cause mortality in type 2 diabetic patients. (C) 2012 Elsevier Inc. All rights reserved.