Visit to Visit Hemoglobin A1c Variation and Long-term Risk of Major Adverse Limb Events in Patients With Type 2
Fu-Chih Hsiao1, Yi-Hsin Chan1,2,3,4, Ying-Chang Tung1
1Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan.
Insights
High hemoglobin A1c (HbA1c) variation increases the risk of major adverse limb events (MALEs) and amputations in type 2 diabetes patients. Managing glycemic variability is crucial for preventing these severe complications.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Diabetes Research
Background:
- Glycemic variation is linked to diabetes complications.
- Understanding the impact of hemoglobin A1c (HbA1c) variability on long-term limb health is critical for type 2 diabetes management.
Purpose of the Study:
- To investigate the association between visit-to-visit HbA1c variability and the long-term risk of major adverse limb events (MALEs).
- To determine if HbA1c fluctuations predict adverse limb outcomes in type 2 diabetes.
Main Methods:
- Retrospective database study of 56,872 patients diagnosed with type 2 diabetes.
- Glycemic variation quantified using average real variability of HbA1c measurements over 4 years post-diagnosis.
- Patients followed for long-term incidence of MALEs (revascularization, foot ulcers, amputations).
Main Results:
- Visit-to-visit HbA1c variations were significantly associated with MALEs and lower limb amputations.
- Patients in the highest quartile of HbA1c variation showed increased risks for MALEs (HR 1.25) and amputations (HR 3.05).
Conclusions:
- HbA1c variation is an independent predictor of long-term MALEs and lower limb amputations in type 2 diabetes.
- Controlling glycemic variability may reduce the risk of severe limb complications in diabetic patients.
Context:
Glycemic variation had been demonstrated to be associated with several complications of diabetes.
Objective:
Investigation of the association between visit to visit hemoglobin A1c (HbA1c) variation and the long-term risk of major adverse limb events (MALEs).
Methods:
Retrospective database study. Average real variability was used to represent glycemic variations with all the HbA1c measurements during the 4 following years after the initial diagnosis of type 2 diabetes. Participants were followed from the beginning of the fifth year until death or the end of the follow-up. The association between HbA1c variations and MALEs was evaluated after adjusting for mean HbA1c and baseline characteristics. Included were 56 872 patients at the referral center with a first diagnosis of type 2 diabetes, no lower extremity arterial disease, and at least 1 HbA1c measurement in each of the 4 following years were identified from a multicenter database. The main outcome measure was incidence of a MALE, which was defined as the composite of revascularization, foot ulcers, and lower limb amputations.
Results:
The average number of HbA1c measurements was 12.6. The mean follow-up time was 6.1 years. The cumulative incidence of MALEs was 9.25 per 1000 person-years. Visit to visit HbA1c variations were significantly associated with MALEs and lower limb amputation after multivariate adjustment. People in the highest quartile of variations had increased risks for MALEs (HR 1.25, 95% CI 1.10-1.41) and lower limb amputation (HR 3.05, 95% CI 1.97-4.74).
Conclusion:
HbA1c variation was independently associated with a long-term risk of MALEs and lower limb amputations in patients with type 2 diabetes.
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