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Glycemic variability evaluated by HbA1c rather than fasting plasma glucose is associated with adverse cardiovascular

Lijuan Sheng1, Guifang Yang2,3,4, Xiangping Chai2,3,4

  • 1Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China.

Frontiers in Endocrinology
|February 29, 2024
PubMed

Insights

Increased hemoglobin A1c (HbA1c) variability, not fasting plasma glucose (FPG) variability, is linked to major adverse cardiovascular events (MACEs) in type 2 diabetes. Intensive glucose control may worsen this association.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Glycemic variability is linked to cardiovascular disease risk.
  • Few studies compare HbA1c and FPG variability concerning cardiovascular events in type 2 diabetes mellitus (T2DM).

Purpose of the Study:

  • To investigate the association between HbA1c and FPG variability and major adverse cardiovascular events (MACEs) in T2DM patients.
  • To explore the impact of glucose control strategies on this relationship.

Main Methods:

  • Post hoc analysis of the ACCORD study.
  • Cox proportional hazards models used to assess HbA1c/FPG variability and MACEs incidence.
  • Analysis included 9,547 T2DM patients with a median follow-up of 4.6 years.

Main Results:

  • Higher HbA1c variability quartiles showed a significant increase in MACEs risk (HR 1.37 in the fourth quartile).
  • FPG variability was not significantly associated with MACEs (P for trend=0.28).
  • A U-shaped relationship observed between glycemic variability and MACEs; intensive glucose control amplified MACEs risk with higher HbA1c variability (P for interaction <0.01).

Conclusions:

  • In T2DM, increased HbA1c variability, not FPG variability, is significantly associated with MACEs.
  • Glycemic variability exhibits a U-shaped relationship with MACEs.
  • Glucose control strategy influences the HbA1c variability-MACEs link, with intensive control posing higher risk.
Abstract

Keywords:
HbA1c variabilityMACEsfasting plasma glucose variabilityglycemic variabilitytype 2 diabetes mellitus

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