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KMID : 0191120230380040024
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Journal of Korean Medical Science
2023 Volume.38 No. 4 p.24 ~ p.24
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Long-Term Risk of Cardiovascular Disease Among Type 2 Diabetes Patients According to Average and Visit-to-Visit Variations of HbA1c Levels During the First 3 Years of Diabetes Diagnosis
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Kim Hyun-Ah
Jung Da-Young
Lee Seung-Hwan
Cho Jae-Hyoung
Yim Hyeon-Woo
Kim Hun-Sung
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Abstract
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Background: It remains unclear whether a combination of glycemic variability and glycated hemoglobin (HbA1c) status leads to a higher incidence of cardiovascular disease (CVD). Therefore, to investigate CVD risk according to the glucose control status during early diabetes, we examined visit-to-visit HbA1c variability among patients with type 2 diabetes (T2DM).
Methods: In this 9-year retrospective study, we measured HbA1c levels at each visit and tracked the change in HbA1c levels for 3 years after the first presentation (observation window) in newly diagnosed T2DM patients. We later assessed the occurrence of CVD in the last 3 years (target outcome window) of the study period after allowing a 3-year buffering window. The HbA1c variability score (HVS; divided into quartiles, HVS_Q1?4) was used to determine visit-to-visit HbA1c variability.
Results: Among 4,817 enrolled T2DM patients, the mean HbA1c level was < 7% for the first 3 years. The group with the lowest HVS had the lowest rate of CVD (9.4%; 104/1,109 patients). The highest incidence of CVD of 26.7% (8/30 patients) was found in HVS [≥ 9.0%]_Q3, which was significantly higher than that in HVS [6.0?6.9%]_Q1 (P = 0.006), HVS [6.0?6.9%]_Q2 (P = 0.013), HVS [6.0?6.9%]_Q3 (P = 0.018), and HVS [7.0?7.9%]_Q3 (P = 0.040).
Conclusion: To our knowledge, this is the first long-term study to analyze the importance of both HbA1c change and visit-to-visit HbA1c variability during outpatient visits within the first 3 years. Lowering glucose levels during early diabetes may be more critical than reducing visit-to-visit HbA1c variability.
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KEYWORD
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Blood Glucose, Cardiovascular Disease, Diabetes Mellitus, Glycated Hemoglobin (HbA1c), HbA1c Variability Score
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