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 language | English |
|---|---|
| Pages (from-to) | 1885-1893 |
| Journal | Diabetes, Obesity and Metabolism |
| Volume | 20 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 2018 |
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Keywords
- All-cause mortality
- Cardiovascular risk factors
- Complications
- HbA1c
- Type 2 diabetes
- Variability
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Endocrinology
Cite this
Haemoglobin A1c variability is a strong, independent predictor of all-cause mortality in patients with type 2 diabetes. / Orsi, Emanuela; Solini, Anna; Bonora, Enzo; Fondelli, Cecilia; Trevisan, Roberto; Vedovato, Monica; Cavalot, Franco; Gruden, Gabriella; Morano, Susanna; Nicolucci, Antonio; Penno, Giuseppe; Pugliese, Giuseppe.
In: Diabetes, Obesity and Metabolism, Vol. 20, No. 8, 2018, p. 1885-1893.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Haemoglobin A1c variability is a strong, independent predictor of all-cause mortality in patients with type 2 diabetes
AU - Orsi, Emanuela
AU - Solini, Anna
AU - Bonora, Enzo
AU - Fondelli, Cecilia
AU - Trevisan, Roberto
AU - Vedovato, Monica
AU - Cavalot, Franco
AU - Gruden, Gabriella
AU - Morano, Susanna
AU - Nicolucci, Antonio
AU - Penno, Giuseppe
AU - Pugliese, Giuseppe
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
KW - All-cause mortality
KW - Cardiovascular risk factors
KW - Complications
KW - HbA1c
KW - Type 2 diabetes
KW - Variability
UR - http://www.scopus.com/inward/record.url?scp=85045835162&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045835162&partnerID=8YFLogxK
U2 - 10.1111/dom.13306
DO - 10.1111/dom.13306
M3 - Article
AN - SCOPUS:85045835162
VL - 20
SP - 1885
EP - 1893
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
SN - 1462-8902
IS - 8
ER -