HbA1c trajectory and cardiovascular outcomes: an analysis of data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study

Abstract

Background: We investigated the associations between glycated hemoglobin (HbA1c) trajectories and cardiovascular outcomes using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Methods: We used HbA1c values within the first 2 years of treatment for modeling with a latent class growth model. Groups of HbA1c trajectories were modeled separately in the standard (group 1–group 4) and intensive (group 5–group 8) treatment arms. The primary outcome in the ACCORD study was a composite of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes. Effects of HbA1c trajectories on cardiovascular outcomes were analyzed using a Cox-proportional hazard model. Results: Baseline HbA1c levels for the eight trajectories (group 1–group 8) were 7.8 ± 0.8, 8.2 ± 0.9, 9.3 ± 1.1, 9.6 ± 1.2, 7.8 ± 0.7, 10.1 ± 0.8, 8.3 ± 0.7, and 9.5 ± 1.1%, respectively. The respective values after 2 years of treatment were 7.0 ± 0.6, 7.7 ± 0.7, 8.5 ± 0.9, 10.3 ± 1.3, 6.2 ± 0.4, 6.5 ± 0.6, 7.2 ± 0.6, and 8.5 ± 1.1%. After a median follow-up of 4.8 years, group 5 and group 6 had similar outcomes compared with group 1 (reference group). In contrast, group 3, group 4, and group 8 had higher risks of the primary composite outcome compared with group 1. Conclusion: HbA1c trajectory was associated with cardiovascular outcomes in type 2 diabetes patients with high cardiovascular risk.

A data-driven approach to identify clusters of HbA1c longitudinal trajectories and associated outcomes in type 2 diabetes mellitus: a large population-based cohort study

“…While most of the studies that have aimed at modelling HbA1c progression have used latent class growth modelling (LCGM) with smaller cohorts and shorter follow-up periods,[11,12,20] we identified similar trajectory patterns. For example, we found that deteriorating HbA1c (i.e.,, PC) and extremely high baseline HbA1c (i.e., AC and UC) were associated with worse clinical outcomes, when compared to the cluster with stable values (i.e., OC).…”

“…[10] Using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, Wang et al found worse cardiovascular outcomes among patients with persistent poor glycemic control, when compared to patients with HbA1c around 7%. [11] Similarly, using observational data, Liateerapong and colleagues found that 10-year glycemic control was associated with improved microvascular outcomes. [12]…”

Cardiovascular and renal outcomes of GLP-1 receptor agonists vs. DPP-4 inhibitors and basal insulin in type 2 diabetes mellitus: A systematic review and meta-analysis

“… 9 , 37 , 43 For instance, CVOTs have suggested that HbA 1c reduction was a relevant mediator of the GLP-1 RA beneficial effect on MACE, and this association seemed to be driven by that between HbA 1c lowering and stroke. 44 , 45 Hence, the unavailability of data regarding baseline levels and changes in cardiovascular risk factors represents a limitation of most real-world studies investigating cardiovascular outcomes that might have hindered the interpretation of results.…”