Association of HbA1c With All-cause Mortality Across Varying Degrees of Glycemic Variability in Type 2 Diabetes.
Association of HbA1c With All-cause Mortality Across Varying Degrees of Glycemic Variability in Type 2 Diabetes.
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DOI：
10.1210/clinem/dgab532
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发表时间：
2021-10-21
期刊：
影响因子：
--
通讯作者：
Zhou J
中科院分区：
文献类型：
--
作者：
Lu J;Wang C;Cai J;Shen Y;Chen L;Zhang L;Lu W;Zhu W;Hu G;Xia T;Zhou J
糖化血红蛋白A1c(HbA1c)和血糖变异性与糖尿病相关预后的相互作用仍不清楚。评估糖化血红蛋白与2型糖尿病患者不同程度血糖变异的全因死亡率之间的关系。这是一项在单一转诊中心进行的前瞻性研究。对6090例2型糖尿病住院患者的临床资料进行分析。连续监测3d，得到血糖变异系数[变异系数(CV)]作为血糖变异的量度。用COX比例风险回归模型估计全因死亡率的危险比和95%的危险比。在平均6.8年的随访期中，有815名患者死亡。在血糖变异系数最低和中等水平的患者中，调整混杂因素后，糖化血红蛋白 ≥ 8.0%分别比糖化血红蛋白6.0%~6.9%高136%(95%可信区间1.46~3.81)和92%(95%可信区间1.22~3.0 3)。然而，在血糖变异系数最高的患者中，发现HbA1c与死亡率之间的零关联。HbA1c可能不是血糖变异性高的患者全因死亡率的有力标志。这些个体可能需要新的血糖控制指标，以实现更好的糖尿病管理。
The interaction of glycated hemoglobin A1c (HbA1c) and glycemic variability in relation to diabetes-related outcomes remains unknown. To evaluate the relationship between HbA1c and all-cause mortality across varying degrees of glycemic variability in patients with type 2 diabetes. This was a prospective study conducted in a single referral center. Data of 6090 hospitalized patients with type 2 diabetes was analyzed. Glucose coefficient of variation [coefficient of variation (CV)] was obtained as the measure of glycemic variability by using continuous glucose monitoring for 3 days. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs for all-cause mortality. During a median follow-up of 6.8 years, 815 patients died. In patients with the lowest and middle tertiles of glucose CV, HbA1c ≥ 8.0% was associated with 136% (95% CI 1.46-3.81) and 92% (95% CI 1.22-3.03) higher risks of all-cause mortality, respectively, as compared with HbA1c 6.0%-6.9%, after adjusting for confounders. However, a null association of HbA1c with mortality was found in patients with the highest tertile of glucose CV. HbA1c may not be a robust marker of all-cause mortality in patients with high degree of glycemic variability. New metrics of glycemic control may be needed in these individuals to achieve better diabetes management.
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