Comparative predictive ability of visit-to-visit HbA1c variability measures for microvascular disease risk in type 2
Chen-Yi Yang1, Pei-Fang Su2, Jo-Ying Hung2
1Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.
Insights
Glycemic variability, particularly HbA1c-CV, is a strong predictor of microvascular disease risk in type 2 diabetes patients. This measure is especially important for patients with well-controlled baseline blood sugar levels.
Area of Science:
- Endocrinology
- Diabetology
- Cardiovascular Research
Background:
- Type 2 diabetes (T2D) management often focuses on average HbA1c levels.
- Microvascular disease (MVD) remains a significant complication in T2D.
- The predictive value of different HbA1c measures for MVD risk requires further investigation.
Purpose of the Study:
- To evaluate the association between various HbA1c metrics and microvascular disease (MVD) risk.
- To compare the predictive power of HbA1c variability measures against traditional HbA1c assessments.
- To explore these associations in relation to baseline glycemic control.
Main Methods:
- Utilized linked Taiwanese National Health Insurance Research Database and hospital data.
- Identified a cohort of type 2 diabetes patients.
- Employed Cox proportional hazards models to analyze associations between HbA1c measures (including HbA1c-SD, HbA1c-CV, HVS) and composite MVD events (retinopathy, nephropathy, neuropathy), adjusting for covariates.
Main Results:
- HbA1c variability and mean measures, except HVS, were associated with MVD risk before baseline HbA1c adjustment.
- HbA1c coefficient of variation (HbA1c-CV) demonstrated the strongest association with MVD risk after baseline adjustment.
- Increased HbA1c-CV significantly elevated MVD risk; associations were stronger in patients with baseline HbA1c < 7.5%.
Conclusions:
- HbA1c variability, particularly HbA1c-CV, offers valuable information beyond baseline HbA1c for predicting MVD risk.
- Glycemic variability may be a more critical factor in MVD development for individuals with better baseline glycemic control.
Background:
To assess the associations of various HbA1c measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variability score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes.
Methods:
Linked data between National Cheng Kung University Hospital and Taiwan's National Health Insurance Research Database were utilized to identify the study cohort. The primary outcome was the composite MVD events (retinopathy, nephropathy, or neuropathy) occurring during the study follow-up. Cox model analyses were performed to assess the associations between HbA1c measures and MVD risk, with adjustment for patients' baseline HbA1c, demographics, comorbidities/complications, and treatments.
Results:
In the models without adjustment for baseline HbA1c, all HbA1c variability and mean measures were significantly associated with MVD risk, except HVS. With adjustment for baseline HbA1c, HbA1c-CV had the strongest association with MVD risk. For every unit of increase in HbA1c-CV, the MVD risk significantly increased by 3.42- and 2.81-fold based on the models without and with adjustment for baseline HbA1c, respectively. The associations of HbA1c variability and mean measures with MVD risk in patients with baseline HbA1c < 7.5% (58 mmol/mol) were stronger compared with those in patients with baseline HbA1c ≥ 7.5% (58 mmol/mol).
Conclusions:
HbA1c variability, especially HbA1c-CV, can supplement conventional baseline HbA1c measure for explaining MVD risk. HbA1c variability may play a greater role in MVD outcomes among patients with relatively optimal baseline glycemic control compared to those with relatively poor baseline glycemic control.
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