HbA1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes
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Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
G S Walker1, S G Cunningham2, C A R Sainsbury1
1Diabetes Centre, Gartnavel General Hospital, Glasgow.
Insights
Greater hemoglobin A1c variability is linked to increased mortality and earlier hospital admissions in Type 1 diabetes patients. This study highlights the importance of stable blood glucose control for better outcomes.
Area of Science:
- Endocrinology
- Diabetes Research
- Clinical Epidemiology
Background:
- Glycemic control in Type 1 diabetes (T1D) is crucial for preventing complications.
- While HbA1c levels are monitored, the impact of HbA1c variability on T1D outcomes remains under-investigated.
- Evidence suggests HbA1c variability may contribute to morbidity, but its link to mortality is unclear.
Purpose of the Study:
- To investigate the association between HbA1c variability and mortality in individuals with Type 1 diabetes.
- To determine if increased HbA1c variability predicts a higher risk of death.
- To explore HbA1c variability as a predictor for the first hospital admission in T1D.
Main Methods:
- An observational study utilizing the Scottish Care Information - Diabetes dataset.
- Inclusion of 6048 individuals diagnosed with Type 1 diabetes.
- Survival analysis over 47 months using Cox proportional hazard models, comparing groups based on median HbA1c coefficient of variation (CV).
Main Results:
- Individuals with HbA1c CV above the median (7.9) exhibited a 1.5-fold increased hazard ratio for mortality over 47 months (P < 0.001).
- A hazard ratio of 1.35 (95% CI 1.25-1.45) was observed for survival to first hospital admission or death within 730 days for those with higher HbA1c variability (P < 0.001).
Conclusions:
- Increased HbA1c variability is significantly associated with a higher mortality rate in Type 1 diabetes.
- Greater glycemic variability also predicts earlier hospital admissions in the T1D population.
- These findings underscore the clinical significance of monitoring and managing HbA1c variability for improved T1D patient outcomes.
Aim:
Despite evidence of morbidity, no evidence exists on the relationship between HbA1c variability and mortality in Type 1 diabetes. We performed an observational study to investigate whether the association between HbA1c variability and mortality exists in a population of people with Type 1 diabetes. As a secondary outcome, we compared onset of first hospital admission between groups.
Methods:
People with Type 1 diabetes were identified for inclusion from the Scottish Care Information - Diabetes data set. This database includes data of all people known to have diabetes who live within Scotland. A survival analysis was carried out over a 47-month period comparing two groups; group 1 with a HbA1c coefficient of variation (CV) above the median CV value, and group 2 with a CV below the median value. Time to death or first admission was also analysed. A Cox proportional hazard model was used to compare time to death, adjusting for appropriate covariables.
Results:
Some 6048 individuals with Type 1 diabetes were included in the analysis. Median HbA1c CV was 7.9. The hazard ratio (HR) for mortality for those with an HbA1c CV above the median value is 1.5 over 47 months of follow-up (P < 0.001). HR for survival to either the first admission to hospital or death for those with an HbA1c CV above the median value was 1.35 (95% confidence interval 1.25-1.45) over 730 days of follow-up (P < 0.001).
Conclusion:
Our results show that people with greater HbA1c variability have a higher rate of mortality and earlier hospital admission in Type 1 diabetes.
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