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Association between hemoglobin A1c variability and subclinical coronary atherosclerosis in subjects with type 2

Hae Kyung Yang1, Borami Kang1, Seung-Hwan Lee1

  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Journal of Diabetes and Its Complications
|May 12, 2015
PubMed

Insights

High hemoglobin A1c (HbA1c) variability, not just the average, is linked to coronary artery disease in type 2 diabetes patients. Stabilizing blood glucose may prevent early heart issues.

Area of Science:

  • Cardiology
  • Endocrinology
  • Diabetology

Background:

  • Type 2 diabetes (T2D) management often focuses on average blood glucose control.
  • However, blood glucose fluctuations (variability) may also impact cardiovascular health.
  • Subclinical coronary atherosclerosis is a key indicator of cardiovascular risk.

Purpose of the Study:

  • To investigate the association between hemoglobin A1c (HbA1c) variability and subclinical coronary atherosclerosis in individuals with T2D.
  • To determine if HbA1c variability is an independent risk factor for coronary artery disease in this population.

Main Methods:

  • Retrospective analysis of coronary computed tomography data from 595 T2D patients without prior cardiovascular disease.
  • Calculation of HbA1c variability metrics: intraindividual standard deviation (HbA1c-SD) and coefficient of variation (HbA1c-CV).
  • Definition of subclinical coronary atherosclerosis as a coronary calcium score >400.

Main Results:

  • Higher HbA1c variability (both HbA1c-SD and HbA1c-CV) was associated with a greater prevalence of subclinical coronary atherosclerosis.
  • This association remained significant even after adjusting for mean HbA1c levels in patients with diabetes duration of 10 years or less.
  • Odds ratios for subclinical coronary atherosclerosis were 2.894 for higher HbA1c-SD and 2.540 for higher HbA1c-CV.

Conclusions:

  • Long-term blood glucose stabilization is crucial for preventing subclinical coronary atherosclerosis in early-stage type 2 diabetes.
  • HbA1c variability is an important, independent predictor of coronary artery disease in T2D patients.
  • Clinical focus should include managing glucose fluctuations alongside average HbA1c levels.
Abstract

Keywords:
Coronary artery diseaseHemoglobin A1cHemoglobin A1c variabilityMultidetector computed tomographyType 2 diabetes mellitus

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