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Visit-to-visit glycated hemoglobin A1c variability in adults with type 2 diabetes: a systematic review and

Furong Qu1, Qingyang Shi2, Yang Wang1

  • 1Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

Chinese Medical Journal
|August 11, 2022
PubMed

Insights

High glycated hemoglobin (HbA1c) variability increases the risk of death and complications in type 2 diabetes patients. Monitoring HbA1c variability is crucial for managing adverse outcomes.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Clinical Research

Background:

  • Current type 2 diabetes management relies on the latest glycated hemoglobin (HbA1c) measure.
  • HbA1c variability is linked to increased mortality and complications, but its clinical role remains unclear.
  • This review examines visit-to-visit HbA1c variability and its association with adverse outcomes in type 2 diabetes.

Approach:

  • Systematic review and random-effects meta-analysis.
  • Searched PubMed, EMBASE, and CENTRAL for studies on HbA1c variability and adverse outcomes in type 2 diabetes.
  • Stratified analysis by HbA1c variability metrics: standard deviation (SD), coefficient of variation (CV), and HbA1c variability score (HVS).

Key Points:

  • Elevated HbA1c variability (using SD, CV, or HVS) is associated with higher risks of all-cause mortality.
  • High HbA1c variability correlates with increased cardiovascular events, chronic kidney disease progression, amputation, and peripheral neuropathy.
  • Hazard ratios indicate significant risk increases for mortality and complications with higher HbA1c variability.

Conclusions:

  • High HbA1c variability is a significant risk factor for micro- and macro-vascular complications in type 2 diabetes.
  • Increased mortality risk is associated with high HbA1c variability in type 2 diabetes patients.
  • Individuals with type 2 diabetes and high HbA1c variability require intensified monitoring and care to mitigate adverse outcomes.
Abstract

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