Glycohemoglobin Variations and Long-term Risk of Incident Heart Failure in Patients With Type 2 Diabetes

To investigate the association between long-term glycohemoglobin variations and the onset of incident heart failure (HF) in individuals with diabetes, addressing the phenotype concerning left ventricular ejection fraction and etiology.

This retrospective study identified patients with type 2 diabetes from a multicenter database between January 2007 and December 2010 who had multiple hemoglobin A_1c (HbA_1c) measurements during the 4 years after the initial diagnosis of diabetes, calculating variations using average real variability. Patients were followed from the end of run-in period, with HF hospitalization as the primary outcome. Cox proportional hazard models, adjusted for mean HbA_1c and baseline characteristics, were used to evaluate the relationship between HbA_1c variations and outcomes.

We identified 53,748 patients with an average of 12.7 HbA_1c measurements. The average follow-up time was 6.2 years, and the cumulative incidence of HF hospitalization was 6.0 per 1000 person-years. Patients with an average visit-to-visit change in HbA_1c exceeding 0.778% were independently associated an elevated risk of hospitalization (HR, 1.28; 95% CI, 1.09 to 1.52). This association persisted regardless of reduced (HR, 1.31; 95% CI, 1.02 to 1.68) or preserved ejection fraction (HR, 1.26; 95% CI, 1.01 to 1.58) and ischemic (HR, 1.30; 95% CI, 1.04 to 1.61) or nonischemic HF (HR, 1.71; 95% CI 1.34 to 2.18).

Hemoglobin A_1c variations independently correlated with increased risk of HF hospitalization, encompassing both reduced and preserved ejection fraction, as well as ischemic and nonischemic HF. An average visit-to-visit change in HbA_1c exceeding 0.778% can serve as a simple indicator for the risk of HF in patients with type 2 diabetes.