Mean and variability of annual haemoglobin A1c are associated with high-risk peripheral artery disease

Abstract

Background: Glucose variability is predictive of cardiovascular events and all-cause mortality. However, the association between peripheral artery disease and glucose variability has not been thoroughly investigated. Therefore, the standard deviation of annual haemoglobin A1c was assessed in patients with type 2 diabetes for evaluating the different risks of peripheral artery disease. Methods: A total of 4144 patients underwent an evaluation for the ankle-brachial index and the percentage of mean arterial pressure at the ankle. The first haemoglobin A1c record was retrospectively collected from each year until the ankle-brachial index measurement. Results: The standard deviation of annual haemoglobin A1c was higher in patients with ankle-brachial index ⩽0.90 than in those with ankle-brachial index >0.90 (1.1 ± 0.9% vs 1.0 ± 0.8%, p = 0.009) and was higher in patients with percentage of mean arterial pressure ⩾45% than in those with percentage of mean arterial pressure <45% (1.1 ± 0.8% vs 1.0 ± 0.8%, p = 0.007). A high standard deviation and mean of annual haemoglobin A1c are associated with high-risk peripheral artery disease, which is defined as a combination of ankle-brachial index ⩽0.90, percentage of mean arterial pressure ⩾45% or both (odds ratio = 1.306; 95% confidence interval = 1.057–1.615; p = 0.014). Conclusion: Fluctuation in the haemoglobin A1c value indicates higher risk for peripheral artery disease in patients with type 2 diabetes and poor glucose control.

Use of the ankle-brachial index combined with the percentage of mean arterial pressure at the ankle to improve prediction of all-cause mortality in type 2 diabetes mellitus: An observational study

“…The baPWV was calculated as (distance from the suprasternal notch to the brachiumdistance from the suprasternal notch to the ankle)/(the time interval between waves detected at the brachium and ankle), where the distances from the suprasternal notch to the brachium and ankle were estimated based on the patient's body height [18]. The reproducibility of the ABI and %MAP has been demonstrated in our previous study [19], and the 95% con dence interval (CI) between repeated measurements of baPWV was 4.95 ± 46.46 cm/sec based on Bland-Altman plots. The lower ABI value and the higher %MAP and baPWV values between lower limbs in an individual were used for the analyses.…”

“…The lower ABI value and the higher %MAP and baPWV values between lower limbs in an individual were used for the analyses. ABI ≤ 0.90 and %MAP > 45% were de ned as abnormal [13,19].…”

Use of the Combination of Ankle-brachial Index and Percentage of Mean Arterial Pressure at Ankle for Improving Prediction of All-cause Mortality in type 2 Diabetes Mellitus

“…In the present study, the risk factors signi cantly associated with %MAP in both the different ABI groups, included age, CVD history, BMI, HbA1c, eGFR, UACR, baPWV, use of antiplatelet agents, type of oral antihyperglycemic drug, and type of hypertensive drug (Table 1). However, we did not include all cardiovascular risk factors in the present study; for example, a higher HbA1c variability has been previously reported to be associated with a higher %MAP [15]. Furthermore, this study has several limitations.…”

“…The %MAP value was automatically determined based on the ankle pulse volume waveform during ABI measurement. The reproducibilities of the ABI and %MAP have been demonstrated using Bland-Altman plots in our previous study [15]. The lower ABI value, and the higher %MAP and baPWV values between lower limbs in an individual were used for the analyses.…”

“…The lower ABI value, and the higher %MAP and baPWV values between lower limbs in an individual were used for the analyses. ABI ≤ 0.90 and %MAP > 45% were de ned as abnormal [12,15].…”