Long-term variability of glycemic markers and risk of all-cause mortality in type 2 diabetes: the Look AHEAD study.
Long-term variability of glycemic markers and risk of all-cause mortality in type 2 diabetes: the Look AHEAD study.
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DOI：
10.1136/bmjdrc-2020-001753
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发表时间：
2020-11
影响因子：
4.1
通讯作者：
Echouffo-Tcheugui JB
中科院分区：
文献类型：
--
作者：
Kaze AD;Santhanam P;Erqou S;Ahima RS;Echouffo-Tcheugui JB
2型糖尿病患者的血糖变异性可能预示预后不良。我们评估了2型糖尿病患者糖化血红蛋白（HbA 1C）和空腹血糖（FPG）的长期变异性与心血管疾病（CVD）和死亡的关系。我们对Look AHEAD（糖尿病健康行动）数据进行了二次前瞻性队列分析，包括3560名参与者，他们在开始时参加了四次访视（基线，12个月，24个月和36个月）。使用4次研究访视测量的4个指标评估HbA 1C和FPG的变异性。在前36个月内没有CVD的参与者被随访事件结局，包括CVD复合事件（心肌梗死、卒中、心绞痛住院和CVD相关死亡）、心力衰竭（HF）和死亡。在6.8年的中位随访中，有164例任何原因的死亡，33例CVD相关死亡，91例HF事件，340例参与者经历了CVD复合事件。比较HbA 1C SD的最高四分位数与最低四分位数的校正HR为2.10（95% CI 1.26 - 3.51），3.43（95% CI 0.95 - 12.38），1.01全因死亡率、CVD死亡率、CVD复合终点和HF分别为1.71（95% CI 0.69 - 1.46）和1.71（95% CI 0.69 - 4.24）。FPG SD最高与最低四分位数的等效HR分别为1.66（95% CI 0.96 - 2.85）、2.20（95% CI 0.67 - 7.25）、0.94（95% CI 0.65 - 1.35）和2.05（95% CI 0.80 - 5.31）。HbA 1C变异性越大，死亡风险越高。我们的研究结果强调了需要实现正常和一致的血糖控制，以改善2型糖尿病患者的临床结局。
Glycemic variability may predict poor outcomes in type 2 diabetes. We evaluated the associations of long-term variability in glycosylated hemoglobin (HbA1C) and fasting plasma glucose (FPG) with cardiovascular disease (CVD) and death among individuals with type 2 diabetes. We conducted a secondary, prospective cohort analysis of the Look AHEAD (Action for Health in Diabetes) data, including 3560 participants who attended four visits (baseline, 12 months, 24 months, and 36 months) at the outset. Variability of HbA1C and FPG was assessed using four indices across measurements from four study visits. Participants without CVD during the first 36 months were followed for incident outcomes including a CVD composite (myocardial infarction, stroke, hospitalization for angina, and CVD-related deaths), heart failure (HF), and deaths. Over a median follow-up of 6.8 years, there were 164 deaths from any cause, 33 CVD-related deaths, 91 HF events, and 340 participants experienced the CVD composite. Adjusted HRs comparing the highest to lowest quartile of SD of HbA1C were 2.10 (95% CI 1.26 to 3.51), 3.43 (95% CI 0.95 to 12.38), 1.01 (95% CI 0.69 to 1.46), and 1.71 (95% CI 0.69 to 4.24) for all-cause mortality, CVD mortality, CVD composite and HF, respectively. The equivalent HRs for highest versus lowest quartile of SD of FPG were 1.66 (95% CI 0.96 to 2.85), 2.20 (95% CI 0.67 to 7.25), 0.94 (95% CI 0.65 to 1.35), and 2.05 (95% CI 0.80 to 5.31), respectively. A greater variability in HbA1C was associated with elevated risk of mortality. Our findings underscore the need to achieve normal and consistent glycemic control to improve clinical outcomes among individuals with type 2 diabetes.
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