HbA1c variability as an independent predictor of diabetes retinopathy in patients with type 2 diabetes

Hu, Jiaqi; Hsu, Hui‐Chun; Yuan, Xun; Lou, Kezheng; Hsue, Cunyi; Miller, Joshua D.; Lu, Juming; Lee, Yaujiunn; Lou, Qingqing

doi:10.1007/s40618-020-01410-6

Cited by 6 publications

(14 citation statements)

References 26 publications

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“…In addition, the differences in the definition of DPN among studies might also be responsible for this discrepancy. Although the accumulated evidence suggests that long-term glycemic variability may be a predictor of renal diseases and retinopathy [ 15 , 41 – 43 ], there is still a paucity of relevant data on DPN in patients with T2DM. Hence, further research is warranted to determine its relationship with the development of DPN in patients with T2DM.…”

Section: Discussionmentioning

confidence: 99%

Association Between HbA1c Levels and Diabetic Peripheral Neuropathy: A Case–Control Study of Patients with Type 2 Diabetes Using Claims Data

Nozawa

Kikuchi

2022

Drugs - Real World Outcomes

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Background Evidence on the efficacy of glycemic control for diabetic peripheral neuropathy (DPN) is limited in patients with type 2 diabetes mellitus. Despite the known relationship between hemoglobin A1c (HbA1c) and DPN, the parameters (e.g., mean values or variability) that play an important role have not been elucidated. Objective The objective of this study was to explore factors associated with DPN, including long-term HbA1c parameters, among patients with type 2 diabetes, in a large-scale longitudinal study. Methods We conducted a case-control study using a medical claims database. We extracted data of patients with type 2 diabetes and disease records of DPN (indicating that they received treatment for DPN) and those without DPN records (controls), and matched for age, sex, index year, and duration since the first type 2 diabetes record. A logistic regression analysis was performed to explore factors associated with DPN, and a receiver-operating characteristic analysis to estimate the optimal mean HbA1c target. Results Of 1,792,037 patients with type 2 diabetes, data from 1632 patients (816 per group) were analyzed. The mean HbA1c levels in the 3-year observation period were 7.2 ± 1.0% in the DPN group and 6.9 ± 1.1% in the control group. Elevated 3-year mean HbA1c levels were significantly associated with DPN records (adjusted odds ratio: 1.23, 95% confidence interval 1.06–1.42), while HbA1c variability was not significantly associated. The mean HbA1c levels that discriminated between patients with and without DPN records were 6.5% (unadjusted) and 7.1% (adjusted). Conclusions The development or progression of DPN in patients with type 2 diabetes was associated with the 3-year mean HbA1c level in real-world data. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-022-00309-3.

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Section: Discussionmentioning

confidence: 99%

Association Between HbA1c Levels and Diabetic Peripheral Neuropathy: A Case–Control Study of Patients with Type 2 Diabetes Using Claims Data

Nozawa

Kikuchi

2022

Drugs - Real World Outcomes

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“…One meta-analysis reported that DR was associated with the long-term HbA1c variability in type 1 DM but not in type 2 DM [ 28 ]. However, recent study with a long follow-up period reported that HbA1c variability played an important role in the development of DR when the HbA1c variability was high (>0.75% [ 10 ]; the cutoff value of HbA1c SD was 1.24 [ 9 ]). One longitudinal study in Taiwan that included 3152 type 2 DM patients who were followed-up for at least 2 years showed that HbA1c variability is an independent risk factor for DR. HbA1c variability may play a role in DR development when the mean value of HbA1c variability index is >0.75% [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, recent study with a long follow-up period reported that HbA1c variability played an important role in the development of DR when the HbA1c variability was high (>0.75% [ 10 ]; the cutoff value of HbA1c SD was 1.24 [ 9 ]). One longitudinal study in Taiwan that included 3152 type 2 DM patients who were followed-up for at least 2 years showed that HbA1c variability is an independent risk factor for DR. HbA1c variability may play a role in DR development when the mean value of HbA1c variability index is >0.75% [ 10 ]. The HbA1c standard deviation was associated with a risk of ≥3 steps of progression on the Early Treatment DR Study person scale as well as progression to PDR in a Korean retrospective study that had a follow-up period of more than 5 years [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…High HbA1c standard deviations were reported as a predictor for DR development in two longitudinal studies with a large sample size among Asians with type 2 DM and long follow-up period [ 9 , 10 ]. In addition, the HbA1c standard deviation may play a greater role in DR development than the mean HbA1c when the HbA1c variation magnitude is wide.…”

Section: Introductionmentioning

confidence: 99%

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Glycemic Gap as a Useful Surrogate Marker for Glucose Variability and Progression of Diabetic Retinopathy

Hsing

Lin

Chen

et al. 2021

JPM

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(1) Background: Recent studies have reported that the glucose variability (GV), irrespective of glycosylated hemoglobin (HbA1c), could be an additional risk factor for the development of diabetic retinopathy (DR). However, measurements for GV, such as continuous glucose monitoring (CGM) and fasting plasma glucose (FPG) variability, are expensive and time consuming. (2) Methods: This present study aims to explore the correlation between the glycemic gap as a measurement of GV, and DR. In total, 2565 patients were included in this study. We evaluated the effect of the different types of glycemic gaps on DR progression. (3) Results: We found that the area under the curve (AUC) values of both the glycemic gap and negative glycemic gap showed an association with DR progression. (4) Conclusions: On eliminating the possible influences of chronic blood glucose controls, the results show that GV has deleterious effects that are associated with the progression of DR. The glycemic gap is a simple measurement of GV, and the predictive value of the negative glycemic gap in DR progression shows that GV and treatment-related hypoglycemia may cause the development of DR. Individual treatment goals with a reasonable HbA1c and minimal glucose fluctuations may help in preventing DR.

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“…However, growing evidence shows that getting HbAlc to target is no longer sufficient for people with type 2 diabetes [3–5] . Recently, considerable evidence has accumulated that increased visit-to-visit change of HbAlc links the risk of death and complications of type 2 diabetes independent of a mean elevation of HbAlc [6–9] …”

Section: Introductionmentioning

confidence: 99%

Visit-to-visit glycated hemoglobin A1c variability in adults with type 2 diabetes: a systematic review and meta-analysis

Shi

Wang

et al. 2022

Chinese Medical Journal

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Background: Current practice uses the latest measure of glycated hemoglobin (HbAlc) to facilitate clinical decision-making. Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes. However, the role of HbAlc variability is unclear in clinical practice. This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro-and macro-vascular complications and death in people with type 2 diabetes. Methods: We searched PubMed, EMBASE (via OVID), and Cochrane Central Register (CENTRAL, via OVID) for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation (SD), coefficient of variation (CV), and HbAlc variability score (HVS). Results: In people with type 2 diabetes, the highest quantile of all three HbAlc variability metrics (HbAlc-standard deviation [HbAlc-SD], HbAlc-coefficient of variance [HbAlc-CV], and HVS) is associated with increased risks of all-cause mortality, cardiovascular events, progression to chronic kidney disease, amputation, and peripheral neuropathy. For example, the hazard ratio of HbAlc-SD on all-cause mortality was l.89 with 95% confidence interval (95% CI) l. ; HVS l.67, 95% CI l.34-2.09). Conclusions: High HbAlc variability leads to micro-and macro-vascular complications of type 2 diabetes and related death. People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.

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HbA1c variability as an independent predictor of diabetes retinopathy in patients with type 2 diabetes

Cited by 6 publications

References 26 publications

Association Between HbA1c Levels and Diabetic Peripheral Neuropathy: A Case–Control Study of Patients with Type 2 Diabetes Using Claims Data

Association Between HbA1c Levels and Diabetic Peripheral Neuropathy: A Case–Control Study of Patients with Type 2 Diabetes Using Claims Data

Glycemic Gap as a Useful Surrogate Marker for Glucose Variability and Progression of Diabetic Retinopathy

Visit-to-visit glycated hemoglobin A1c variability in adults with type 2 diabetes: a systematic review and meta-analysis

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