Association of hemoglobin A1c stability with mortality and diabetes complications in older adults with diabetes.
Association of hemoglobin A1c stability with mortality and diabetes complications in older adults with diabetes.
复制标题
血红蛋白A1C稳定性与糖尿病老年人的死亡率和糖尿病并发症的关联。
DOI：
10.1136/bmjdrc-2022-003211
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发表时间：
2023-04
影响因子：
4.1
通讯作者：
Mohr, David C.
中科院分区：
文献类型：
--
作者：
Conlin, Paul R.;Zhang, Libin;Li, Donglin;Nelson, Richard E.;Prentice, Julia C.;Mohr, David C.
老年人的糖化血红蛋白（A1c）治疗目标应个体化，以平衡风险和收益。目前尚不清楚糖化血红蛋白在特定目标范围内的长期稳定性是否也会影响不良后果。我们对2004年至2016年患有糖尿病的退伍军人进行了一项回顾性观察队列研究，并在3年基线期间进行了至少4次A1c检测。根据基线A1c水平在患者特定目标范围内的时间百分比，我们产生了四个不同的类别：≥60%的时间在范围内（TIR），≥60%的时间低于范围（TBR），≥60%的时间高于范围（TAR），以及所有时间<60%的混合组。我们评估了这些类别与死亡率、大血管和微血管并发症的关系。我们研究了397 634例患者（平均年龄76.9岁，SD 5.7），平均随访5.5年。与A1c≥60%的TIR相比，TBR≥60%、TAR≥60%和混合组的死亡率增加，hr分别为1.12 （95% CI 1.11 ~ 1.14）、1.10 （95% CI 1.08 ~ 1.12）和1.06 （95% CI 1.04 ~ 1.07）。TBR≥60%和TAR≥60%时，大血管并发症增加，估计分别为1.04 （95% CI 1.01 ~ 1.06）和1.06 （95% CI 1.03 ~ 1.09）。TBR≥60%时微血管并发症发生率较低（HR 0.97, 95% CI 0.95 ~ 1.00）， TAR≥60%时微血管并发症发生率较高（HR 1.11, 95% CI 1.08 ~ 1.14）。结果与较高的TIR阈值、较短的随访和竞争的死亡风险相似。在老年糖尿病患者中，死亡率和大血管并发症与高于和低于个体化A1c目标范围的时间增加有关。较高的A1c TIR可以识别出不良结局风险较低的患者。
Hemoglobin A1c (A1c) treatment goals in older adults should be individualized to balance risks and benefits. It is unclear if A1c stability over time within unique target ranges also affects adverse outcomes. We conducted a retrospective observational cohort study from 2004 to 2016 of veterans with diabetes and at least four A1c tests during a 3-year baseline. We generated four distinct categories based on the percentage of time that baseline A1c levels were within patient-specific target ranges: ≥60% time in range (TIR), ≥60% time below range (TBR), ≥60% time above range (TAR), and a mixed group with all times <60%. We assessed associations of these categories with mortality, macrovascular, and microvascular complications. We studied 397 634 patients (mean age 76.9 years, SD 5.7) with an average of 5.5 years of follow-up. In comparison to ≥60% A1c TIR, mortality was increased with ≥60% TBR, ≥60% TAR, and the mixed group, with HRs of 1.12 (95% CI 1.11 to 1.14), 1.10 (95% CI 1.08 to 1.12), and 1.06 (95% CI 1.04 to 1.07), respectively. Macrovascular complications were increased with ≥60% TBR and ≥60% TAR, with estimates of 1.04 (95% CI 1.01 to 1.06) and 1.06 (95% CI 1.03 to 1.09). Microvascular complications were lower with ≥60% TBR (HR 0.97, 95% CI 0.95 to 1.00) and higher with ≥60% TAR (HR 1.11, 95% CI 1.08 to 1.14). Results were similar with higher TIR thresholds, shorter follow-up, and competing risk of mortality. In older adults with diabetes, mortality and macrovascular complications are associated with increased time above and below individualized A1c target ranges. Higher A1c TIR may identify patients with lower risk of adverse outcomes.
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影响因子：
16.2
作者：
Riddle MC;Ambrosius WT;Brillon DJ;Buse JB;Byington RP;Cohen RM;Goff DC Jr;Malozowski S;Margolis KL;Probstfield JL;Schnall A;Seaquist ER;Action to Control Cardiovascular Risk in Diabetes Investigators
通讯作者：
Action to Control Cardiovascular Risk in Diabetes Investigators
影响因子：
168.9
作者：
Turner, RC;Holman, RR;Ward, JD
通讯作者：
Ward, JD
影响因子：
120.7
作者：
Martens, Thomas;Beck, Roy W.;Group, Mobile Study
通讯作者：
Group, Mobile Study
影响因子：
39.2
作者：
Conlin, Paul R.;Colburn, Jeffrey;Pogach, Leonard
通讯作者：
Pogach, Leonard
影响因子：
16.2
作者：
Critchley, Julia A.;Carey, Iain M.;Cook, Derek G.
通讯作者：
Cook, Derek G.