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Article: Age‐specific associations of glycated haemoglobin variability with cardiovascular disease and mortality in patients with type 2 diabetes mellitus: A 10‐ year cohort study

TitleAge‐specific associations of glycated haemoglobin variability with cardiovascular disease and mortality in patients with type 2 diabetes mellitus: A 10‐ year cohort study
Authors
Keywordscardiovascular disease
diabetes
glycated haemoglobin
mortality
variability
Issue Date2020
PublisherWiley-Blackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/DOM
Citation
Diabetes, Obesity and Metabolism, 2020, v. 22 n. 8, p. 1316-1327 How to Cite?
AbstractAims: To investigate the associations of increased variability in glycated haemoglobin (HbA1c) with cardiovascular disease (CVD) and mortality risk in patients with diabetes. Materials and Methods: This prospective cohort study included 147 811 patients aged 45 to 84 years with type 2 diabetes mellitus, without CVD and with at least three HbA1c values recorded before baseline in the period 2008 to 2010. HbA1c variability was evaluated using a mixed effects model to reduce regression dilution bias. Age‐specific associations (45– 54, 55– 64, 65– 74 and 75– 84 years) between HbA1c variability and risk of CVD and mortality were assessed by Cox regression, adjusted for patient characteristics and usual HbA1c. Results: After a median follow‐up of 7.4 years(1.02 million person‐years), an overall incidence of 40 785 events including CVD (incidence 27  793) and all‐cause mortalities (incidence 23 175) were identified. Positive log‐linear associations between HbA1c variability and CVD and mortality were identified in all age groups. The hazard ratios (HRs) for the composite of CVD and all‐cause mortality showed that age was inversely associated with HbA1c variability, with a 28% higher risk per 1% increase in HbA1c variability in the age group 45 to 54 years (all composite outcomes: HR 1.28, 95% confidence interval [CI] 1.21, 1.35), whereas only a 14% higher risk in the 75– 84 age group (all composite outcomes: HR 1.14, 95% CI 1.11, 1.17). Subgroup analysis showed the risk in patients with usual HbA1c <53mmol/mol was about eight times higher than in those with usual HbA1c ≥64mmol/mol. Conclusions: HbA1c variability was strongly related to CVD and mortality in patients with diabetes across all age groups. Whilst pursuing optimal HbA1c targets, attention should be given to patients with high HbA1c variability, especially younger patients with good HbA1c control.
Persistent Identifierhttp://hdl.handle.net/10722/284564
ISSN
2020 Impact Factor: 6.577
2020 SCImago Journal Rankings: 2.445
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWan, EYF-
dc.contributor.authorYu, EYT-
dc.contributor.authorChin, WY-
dc.contributor.authorNg, FTY-
dc.contributor.authorChia, SMC-
dc.contributor.authorWong, ICK-
dc.contributor.authorChan, EWY-
dc.contributor.authorLam, CLK-
dc.date.accessioned2020-08-07T08:59:26Z-
dc.date.available2020-08-07T08:59:26Z-
dc.date.issued2020-
dc.identifier.citationDiabetes, Obesity and Metabolism, 2020, v. 22 n. 8, p. 1316-1327-
dc.identifier.issn1462-8902-
dc.identifier.urihttp://hdl.handle.net/10722/284564-
dc.description.abstractAims: To investigate the associations of increased variability in glycated haemoglobin (HbA1c) with cardiovascular disease (CVD) and mortality risk in patients with diabetes. Materials and Methods: This prospective cohort study included 147 811 patients aged 45 to 84 years with type 2 diabetes mellitus, without CVD and with at least three HbA1c values recorded before baseline in the period 2008 to 2010. HbA1c variability was evaluated using a mixed effects model to reduce regression dilution bias. Age‐specific associations (45– 54, 55– 64, 65– 74 and 75– 84 years) between HbA1c variability and risk of CVD and mortality were assessed by Cox regression, adjusted for patient characteristics and usual HbA1c. Results: After a median follow‐up of 7.4 years(1.02 million person‐years), an overall incidence of 40 785 events including CVD (incidence 27  793) and all‐cause mortalities (incidence 23 175) were identified. Positive log‐linear associations between HbA1c variability and CVD and mortality were identified in all age groups. The hazard ratios (HRs) for the composite of CVD and all‐cause mortality showed that age was inversely associated with HbA1c variability, with a 28% higher risk per 1% increase in HbA1c variability in the age group 45 to 54 years (all composite outcomes: HR 1.28, 95% confidence interval [CI] 1.21, 1.35), whereas only a 14% higher risk in the 75– 84 age group (all composite outcomes: HR 1.14, 95% CI 1.11, 1.17). Subgroup analysis showed the risk in patients with usual HbA1c <53mmol/mol was about eight times higher than in those with usual HbA1c ≥64mmol/mol. Conclusions: HbA1c variability was strongly related to CVD and mortality in patients with diabetes across all age groups. Whilst pursuing optimal HbA1c targets, attention should be given to patients with high HbA1c variability, especially younger patients with good HbA1c control.-
dc.languageeng-
dc.publisherWiley-Blackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/DOM-
dc.relation.ispartofDiabetes, Obesity and Metabolism-
dc.rightsThis is the peer reviewed version of the following article: Diabetes, Obesity and Metabolism, 2020, v. 22 n. 8, p. 1316-1327, which has been published in final form at https://doi.org/10.1111/dom.14034. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.-
dc.subjectcardiovascular disease-
dc.subjectdiabetes-
dc.subjectglycated haemoglobin-
dc.subjectmortality-
dc.subjectvariability-
dc.titleAge‐specific associations of glycated haemoglobin variability with cardiovascular disease and mortality in patients with type 2 diabetes mellitus: A 10‐ year cohort study-
dc.typeArticle-
dc.identifier.emailWan, EYF: yfwan@hku.hk-
dc.identifier.emailYu, EYT: ytyu@hku.hk-
dc.identifier.emailChin, WY: chinwy@hku.hk-
dc.identifier.emailNg, FTY: flotyng@hku.hk-
dc.identifier.emailWong, ICK: wongick@hku.hk-
dc.identifier.emailChan, EWY: ewchan@hku.hk-
dc.identifier.emailLam, CLK: clklam@hku.hk-
dc.identifier.authorityWan, EYF=rp02518-
dc.identifier.authorityYu, EYT=rp01693-
dc.identifier.authorityChin, WY=rp00290-
dc.identifier.authorityWong, ICK=rp01480-
dc.identifier.authorityChan, EWY=rp01587-
dc.identifier.authorityLam, CLK=rp00350-
dc.description.naturepostprint-
dc.identifier.doi10.1111/dom.14034-
dc.identifier.pmid32196917-
dc.identifier.scopuseid_2-s2.0-85083465988-
dc.identifier.hkuros311610-
dc.identifier.volume22-
dc.identifier.issue8-
dc.identifier.spage1316-
dc.identifier.epage1327-
dc.identifier.isiWOS:000525792700001-
dc.publisher.placeUnited Kingdom-
dc.identifier.issnl1462-8902-

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