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Visit-to-visit HbA1c variability is associated with in-stent restenosis in patients with type 2 diabetes after

Chen Die Yang1, Ying Shen1, Lin Lu1,2

  • 1Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China.

Cardiovascular Diabetology
|September 5, 2020
PubMed

Insights

Visit-to-visit glycemic variability, measured by HbA1c coefficient of variation, independently predicts in-stent restenosis in type 2 diabetes patients post-stent implantation. Higher variability indicates increased risk, improving risk stratification for these patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Diabetes Mellitus Research

Background:

  • Type 2 diabetes patients face elevated risks of in-stent restenosis (ISR) after coronary stent procedures.
  • Glycemic control, specifically HbA1c variability, is increasingly recognized as a critical factor in cardiovascular outcomes.

Purpose of the Study:

  • To investigate the predictive value of visit-to-visit HbA1c variability for ISR in type 2 diabetes patients.
  • To determine if HbA1c variability offers incremental predictive power beyond mean HbA1c levels for ISR.

Main Methods:

  • A cohort of 420 type 2 diabetes patients undergoing elective percutaneous coronary intervention were followed for approximately 12 months.
  • Visit-to-visit HbA1c variability was assessed using coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM).
  • Multivariable Cox proportional hazards models were employed to analyze the association between HbA1c variability and ISR incidence.

Main Results:

  • The overall incidence of ISR was 8.6%, significantly higher in patients with greater HbA1c CV (P=0.001).
  • Higher HbA1c variability, particularly CV, was linked to increased diameter stenosis and was more pronounced in patients with baseline HbA1c ≤ 7%.
  • HbA1c variability (CV) independently predicted ISR (HR: 3.00 [95% CI 1.14-7.92] for highest vs. lowest tertile) and improved risk stratification accuracy.

Conclusions:

  • Visit-to-visit HbA1c variability is an independent predictor of ISR in type 2 diabetes patients following coronary stent implantation.
  • Assessing HbA1c variability provides valuable prognostic information for managing ISR risk in diabetic patients.
  • These findings highlight the importance of monitoring glycemic fluctuations, not just average levels, for cardiovascular event prevention.
Abstract

Keywords:
Diameter stenosisHbA1c variabilityIn-stent restenosisPercutaneous coronary interventionType 2 diabetes

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