Haemoglobin A1c variability is a strong, independent predictor of all-cause mortality in patients with type 2 diabetes

Emanuela Orsi, Anna Solini, Enzo Bonora, Cecilia Fondelli, Roberto Trevisan, Monica Vedovato, Franco Cavalot, Gabriella Gruden, Susanna Morano, Antonio Nicolucci, Giuseppe Penno, Giuseppe Pugliese

Research output: Contribution to journalArticle

Abstract

Aims: To evaluate various measures of haemoglobin (Hb) A1c variability, compared with average HbA1c, as independent predictors of mortality. Materials and Methods: The Renal Insufficiency And Cardiovascular Events Italian multicentre study enroled 15733 patients with type 2 diabetes from 19 diabetes clinics during 2006-2008. A total of 3 to 5 HbA1c measures, obtained during the 2-year period before enrolment, were available from 9 centres (8290 patients) and were used to calculate average HbA1c (HbA1c -MEAN) and HbA1c variability, measured as intra-individual standard deviation (HbA1c-SD), SD adjusted for the number of HbA1c assessments (HbA1c-AdjSD) and coefficient of variation (HbA1c-CV), that is, the HbA1c-SD to HbA1c-MEAN ratio. Vital status on October 31, 2015 was retrieved for 8252 patients (99.5%). Results: The measures of HbA1c variability increased according to quartiles of HbA1c-MEAN and vice versa. HbA1c-MEAN and measures of HbA1c variability were associated with all-cause mortality; however, the strength of association of HbA1c-MEAN was lower than that of HbA1c -SD, HbA1c-CV or HbA1c-AdjSD, and disappeared after adjusting for confounders and any of the measures of HbA1c variability. Mortality increased with quartiles of HbA1c-MEAN, HbA1c -SD, HbA1c-CV and HbA1c-AdjSD, but only the association with HbA1c variability measures remained after adjustment for confounders and/or each other measure. In the fully adjusted model, mortality risk was lower for HbA1c-SD below the median and higher for HbA1c-SD above the median, regardless of whether HbA1c-MEAN was below or above the median. Conclusions: HbA1c variability is a strong, independent predictor of all-cause mortality in type 2 diabetes and appears to be even more powerful than average HbA1c in predicting mortality.

Original languageEnglish
Pages (from-to)1885-1893
JournalDiabetes, Obesity and Metabolism
Volume20
Issue number8
DOIs
Publication statusPublished - 2018

Keywords

  • All-cause mortality
  • Cardiovascular risk factors
  • Complications
  • HbA1c
  • Type 2 diabetes
  • Variability

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Fingerprint Dive into the research topics of 'Haemoglobin A1c variability is a strong, independent predictor of all-cause mortality in patients with type 2 diabetes'. Together they form a unique fingerprint.

  • Cite this

    Orsi, E., Solini, A., Bonora, E., Fondelli, C., Trevisan, R., Vedovato, M., Cavalot, F., Gruden, G., Morano, S., Nicolucci, A., Penno, G., & Pugliese, G. (2018). Haemoglobin A1c variability is a strong, independent predictor of all-cause mortality in patients with type 2 diabetes. Diabetes, Obesity and Metabolism, 20(8), 1885-1893. https://doi.org/10.1111/dom.13306