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Association of Baseline HbA1c With Cardiovascular and Renal Outcomes: Analyses From DECLARE-TIMI 58

Avivit Cahn1, Stephen D Wiviott2, Ofri Mosenzon1

  • 1Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

Diabetes Care
|January 11, 2022
PubMed

Insights

Higher HbA1c levels increase cardiovascular and renal risks in type 2 diabetes patients. Dapagliflozin provides consistent benefits across all HbA1c levels, including those below 7%.

Area of Science:

  • Cardiology
  • Endocrinology
  • Nephrology

Background:

  • Current guidelines recommend SGLT2 inhibitors for type 2 diabetes patients with or at high risk for atherosclerotic cardiovascular disease (ASCVD).
  • The role of baseline HbA1c in cardiovascular and renal outcomes, and its impact on dapagliflozin's efficacy, requires further investigation.

Purpose of the Study:

  • To investigate the association between baseline HbA1c and cardiovascular/renal outcomes in type 2 diabetes patients.
  • To determine if the cardiovascular and renal benefits of dapagliflozin vary by baseline HbA1c levels.

Main Methods:

  • Analysis of the DECLARE-TIMI 58 trial data involving 17,160 patients with type 2 diabetes randomized to dapagliflozin or placebo.
  • Cox regression models were used to assess outcomes by baseline HbA1c and within dapagliflozin/placebo subgroups.

Main Results:

  • Higher baseline HbA1c correlated with increased risks of cardiovascular death, heart failure hospitalization, MACE, and cardiorenal outcomes.
  • These risks were more pronounced in patients with multiple risk factors (MRF) compared to established ASCVD.
  • Dapagliflozin significantly reduced risks of cardiovascular death/heart failure hospitalization and cardiorenal outcomes, with benefits consistent across all baseline HbA1c subgroups (P-interaction > 0.05).

Conclusions:

  • Elevated HbA1c is linked to heightened cardiovascular and renal risk, especially in the MRF population.
  • Dapagliflozin demonstrates significant benefits for cardiovascular and renal outcomes in type 2 diabetes patients, irrespective of their baseline HbA1c levels.
Abstract

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