Association between HbA1c variability and mortality in patients with type 2 diabetes
Toshiko Takao1, Yutaka Matsuyama2, Hiroyuki Yanagisawa3
1Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan.
Journal of Diabetes and Its Complications
|April 8, 2014
Summary
Glycemic variability, measured by HbA1c standard deviation (SD) or coefficient of variation (CV), predicts all-cause and non-cancer mortality in type 2 diabetes patients. Mean HbA1c level, however, may predict cancer mortality.
Area of Science:
- Endocrinology
- Diabetes Mellitus Research
- Clinical Epidemiology
Background:
- Type 2 diabetes management often focuses on mean HbA1c levels.
- The impact of glycemic variability on patient outcomes requires further investigation.
Purpose of the Study:
- To assess the association between HbA1c variability and mortality in type 2 diabetes.
- To determine if HbA1c variability predicts all-cause, cancer, or non-cancer mortality independently of mean HbA1c.
Main Methods:
- A cohort of 754 type 2 diabetes patients with at least four HbA1c measurements were followed for up to 17 years.
- HbA1c variability was quantified using standard deviation (SD) and coefficient of variation (CV).
- Multivariate Cox proportional hazard models were employed to evaluate mortality risk.
Main Results:
- Increased HbA1c variability (both SD and CV) was associated with higher all-cause and non-cancer mortality, including cardiovascular diseases.
- HbA1c variability did not predict cancer mortality.
- Mean HbA1c level was identified as a predictor of cancer mortality.
Conclusions:
- HbA1c variability is an independent predictor of all-cause and non-cancer mortality in type 2 diabetes.
- Mean HbA1c level, rather than variability, may be a predictor for cancer mortality.
- These findings highlight the importance of considering glycemic variability in diabetes patient risk assessment.
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