The relationship between HbA1c control pattern and atherosclerosis progression of diabetes: a prospective study of
Kun Li1,2, Longyan Yang3,4, Dong Zhao5,6
1Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China.
Insights
Glycosylated hemoglobin (HbA1c) variability is linked to atherosclerosis progression in type 2 diabetes. Maintaining stable blood glucose levels is crucial for managing diabetes complications and preventing cardiovascular issues.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Metabolic Syndrome
Background:
- Glycosylated hemoglobin (HbA1c) control patterns are critical for managing type 2 diabetes.
- Understanding the link between HbA1c variability and atherosclerosis progression is essential for preventing diabetes complications.
Purpose of the Study:
- To comprehensively explain glycosylated hemoglobin (HbA1c) control patterns in type 2 diabetes.
- To determine the causal relationship between glycemic control patterns and atherosclerosis progression.
- To contribute to effective management strategies for diabetes complications.
Main Methods:
- Analysis of HbA1c variability and trajectory groups in 1041 type 2 diabetes patients.
- Examination of associations between HbA1c patterns and intima-media thickness (IMT) changes using multiple linear regression.
- Application of a cross-lagged panel model (CLPM) to verify the bidirectional relationship between IMT and HbA1c.
Main Results:
- HbA1c variability, excluding average real variability (ARV), was associated with intima-media thickness (IMT) changes (P < 0.05).
- Four distinct HbA1c trajectories were identified; moderate-increase, U-shape, and relative high trajectories showed significantly higher IMT changes compared to the low-stable group.
- Significant bidirectional associations were found between HbA1c and IMT after covariate adjustment.
Conclusions:
- Four discrete HbA1c trajectory groups were identified during long-term diabetes follow-up.
- A positive association exists between HbA1c variability and atherosclerosis progression.
- Patients with diabetes should aim for stable blood glucose levels to avoid adverse cardiovascular outcomes.
Background:
This study aims to comprehensively explain of glycosylated Hemoglobin (HbA1c) control patterns and help determine the causal relationship between glycemic control patterns and atherosclerosis progression, thereby contributing to the effective management of diabetes complications.
Method:
All participants registered at the National Metabolic Management Center (MMC) of Beijing Luhe Hospital. The HbA1c pattern was described by HbA1c variability and trajectory groups of HbA1c. Then we examined the associations between the HbA1c pattern and the changes of intima-media thickness (ΔIMT) using covariate-adjusted means (SE) of ΔIMT, which were calculated by multiple linear regression analyses adjusted for the covariates. Finally, a cross-lagged panel model (CLPM) was performed to further verify the bidirectional relationship between IMT and HbA1c.
Results:
After data cleaning, a total of 1041 type 2 diabetes patients aged 20-80 years were included in this study. Except for average real variability (ARV), the other variation variables of HbA1c were associated with ΔIMT% (P < 0.05). Four discrete trajectories of HbA1c were identified in trajectory analysis. Comparing with the low-stable trajectory group of HbA1c, the covariate-adjusted means (SE) of ΔIMT% were significantly higher in Moderate-increase, U-shape and relative high trajectory groups, the mean (SE) were 7.03 (0.031), 15.49 (0.185), 14.15 (0.029), respectively. Meanwhile, there were significant bidirectional cross-lagged associations between HbA1c and IMT after adjusting for covariates.
Conclusion:
We found four discrete trajectory groups of HbA1c during the long-term follow-up of diabetes. There was a positive association between HbA1c variability and the progression of atherosclerosis. Our study suggested that patients with diabetes should avoid roller coaster changes in glucose over a long period when controlling blood glucose.
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