Risk association of HbA<sub>1c</sub> variability with chronic kidney disease and cardiovascular disease in type 2 diabetes: prospective analysis of the Hong Kong Diabetes Registry

Luk, Andrea; Ma, Rong; Lau, Eric S.H.; Yang, Xilin; Lau, Winnie W. Y.; Yu, Lie; Chow, Francis C. C.; Chan, Juliana C.N.; So, Wing‐Yee

doi:10.1002/dmrr.2404

Cited by 127 publications

(173 citation statements)

References 20 publications

Supporting

Mentioning

156

Contrasting

Unclassified

Order By: Relevance

“…Twenty studies in 87,641 participants met the inclusion criteria. Ten studies included participants from Europe (10,11,14,(16)(17)(18)(19)26,29,35,36), eight from Asia (12,13,15,18,20,24,27,28), four from North America (6,18,23, 25), and one from Australasia (18). The number of participants in each study ranged from 234 to 35,891.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

“…Thirteen studies included 43,620 participants with type 2 diabetes (12,13,(15)(16)(17)(18)(19)(20)23,24,(26)(27)(28)36). These comprised six retrospective cohort studies (13,15,20,23,28,36), five prospective cohort studies (12,16,17,19,26,27), and two post hoc analyses of randomized controlled trials (18,24).…”

Section: Type 2 Diabetesmentioning

confidence: 99%

“…These comprised six retrospective cohort studies (13,15,20,23,28,36), five prospective cohort studies (12,16,17,19,26,27), and two post hoc analyses of randomized controlled trials (18,24). All studies used secondary care data apart from one of primary and secondary care data (19) and one of solely U.S. primary care data (23).…”

Section: Type 2 Diabetesmentioning

confidence: 99%

“…A recent meta-analysis concluded that HbA 1c variability, assessed by the SD, is associated with renal disease in type 1 and type 2 diabetes (9). However, no systematic reviews or meta-analyses have evaluated the relationship between long-term glycemic variability and other complications in diabetes, despite contradictory literature providing evidence in support (6,(10)(11)(12)(13)(14)(15) and against (16)(17)(18)(19)(20) such a relationship.…”

mentioning

confidence: 99%

“…First, unlike short-term glycemic variability, longterm glycemic variability may predict complications in both type 1 and type 2 diabetes (6,(10)(11)(12)(13)(14)(15)(21)(22)(23)(24)(25)(26)(27)(28)(29). Second, HbA 1c is routinely recorded in primary care for both types of diabetes, whereas measures of short-term variability are not (30,31).…”

mentioning

confidence: 99%

See 4 more Smart Citations

Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis

et al. 2015

View full text Add to dashboard Cite

OBJECTIVEGlycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA 1c variability and micro-and macrovascular complications and mortality in type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODSMedline and Embase were searched (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) for studies describing associations between HbA 1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA 1c variability, method of analysis, and diabetes type. RESULTS

show abstract

Section: Data Synthesis and Analysismentioning

confidence: 99%

Section: Type 2 Diabetesmentioning

confidence: 99%

Section: Type 2 Diabetesmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis

et al. 2015

View full text Add to dashboard Cite

show abstract

Different glycaemia‐related risk factors for incident Alzheimer's disease in men and women with type 2 diabetes—A sex‐specific analysis of the Hong Kong diabetes database

Lee

Lui

Cheung

et al. 2020

Diabetes Metabolism Res

View full text Add to dashboard Cite

Aims Sexual dimorphism has been reported in the epidemiology, neurobiologic susceptibility and clinical presentation of Alzheimer's disease (AD). As poor glycaemic control is associated with increased risks of AD, we aimed to investigate whether glycaemia‐related risk factors also differ between men and women, using a retrospective, sex‐specific analysis of a large Chinese cohort with diabetes. Materials & Methods A total of 85,514 Chinese individuals with type 2 diabetes (T2D; 46,783 women and 38,731 men), aged ≥60 years, were identified from electronic health records and observed for incident AD. Multivariable Cox regression analysis was used to evaluate the associations with incident AD of several glycaemia‐related risk factors, including severe hypoglycaemia, mean HbA1c and indices of HbA1c variability, in men and women separately. Results Over a median follow‐up of 6 years, women had a higher incidence of AD than men (2.3% vs. 1.2%, p < 0.001). Both men and women shared the same independent non‐glycaemic clinical predictors, which included older age, lower body mass index and longer duration of diabetes. However, for glycaemia‐related risk factors, we observed that severe hypoglycaemia and indices of HbA1c variability were independent predictors of incident AD in women but not in men, and the associations were irrespective of their baseline glycaemic control and duration of diabetes. Conclusions Our findings highlighted that glycaemia‐related risk factors for incident AD differ between men and women with T2D. Strategies to maintain glycaemic stability and avoid severe hypoglycaemia might be especially important to preserve healthy cognition in older women with diabetes.

show abstract

Early treatment with dipeptidyl‐peptidase 4 inhibitors reduces glycaemic variability and delays insulin initiation in type 2 diabetes: A propensity score‐matched cohort study

Cheung,

Yang,

et al. 2023

Diabetes Metabolism Res

Self Cite

View full text Add to dashboard Cite

AimsTo examine whether early treatment intensification using dipeptidyl‐peptidase 4 inhibitors (DPP4i) delays insulin initiation in Chinese patients diagnosed with type 2 diabetes for less than 5 years.Materials and MethodsIn a territory‐wide prospective cohort study, patients with type 2 diabetes initiating DPP4i at diabetes duration <2 years (early intensification) and 3–5 years (late intensification) were matched using 1:1 propensity‐score matching (n = 908 in each arm). We used Cox regression to compare the risk of insulin initiation between the two groups. We explored the interactive and mediation effects of glycated haemoglobin (HbA1c) variability score (HVS), defined as the percentage of HbA1c varying by ≥0.5% compared with preceding values.ResultsOf 1816 patients (60.7% men, mean age 54.4 ± 11.9 years), 92.4% and 71.9% were treated with metformin and sulphonylureas respectively at DPP4i initiation. Early DPP4i intensification [hazard ratio (HR) 0.71, (95% CI 0.58–0.68)] and low HVS (<50%) (HR = 0.40, 0.33–0.50) were associated with delayed insulin initiation during a median 4.08 years of follow‐up. Early intensification with low HVS had the lowest risk versus late intensification with high HVS (HR = 0.30, 0.22–0.40) (pinteraction = 0.013). HVS mediated 19.5% of the total effect of early DPP4i intensification on delaying insulin initiation. The late and early intensification groups had similar HbA1c at month 0 (8.4 ± 1.3% vs. 8.4 ± 1.5%) and month 3 (7.6 ± 1.2% vs. 7.6 ± 1.3%) after DPP4i initiation. By month 12, HbA1c in the late intensification group deteriorated (7.9 ± 1.4%) but remained stable in the early intensification group (7.6 ± 1.4%, p = 0.001) with persistent between‐group difference over 72 months (8.2 ± 1.7% vs. 7.7 ± 1.6%, p = 0.001).ConclusionsIn type 2 diabetes, early DPP4i intensification delayed insulin initiation, partially explained by reduced glycaemic variability.

show abstract

Risk association of HbA_1c variability with chronic kidney disease and cardiovascular disease in type 2 diabetes: prospective analysis of the Hong Kong Diabetes Registry

Abstract: Long-term glycaemic variability expressed by SD of HbA1c predicted development of renal and cardiovascular complications.

Cited by 127 publications

References 20 publications

Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis

Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis

Different glycaemia‐related risk factors for incident Alzheimer's disease in men and women with type 2 diabetes—A sex‐specific analysis of the Hong Kong diabetes database

Early treatment with dipeptidyl‐peptidase 4 inhibitors reduces glycaemic variability and delays insulin initiation in type 2 diabetes: A propensity score‐matched cohort study

Contact Info

Product

Resources

About

Risk association of HbA1c variability with chronic kidney disease and cardiovascular disease in type 2 diabetes: prospective analysis of the Hong Kong Diabetes Registry

Abstract: Long-term glycaemic variability expressed by SD of HbA1c predicted development of renal and cardiovascular complications.

Cited by 127 publications

References 20 publications

Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis

Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis

Different glycaemia‐related risk factors for incident Alzheimer's disease in men and women with type 2 diabetes—A sex‐specific analysis of the Hong Kong diabetes database

Early treatment with dipeptidyl‐peptidase 4 inhibitors reduces glycaemic variability and delays insulin initiation in type 2 diabetes: A propensity score‐matched cohort study

Contact Info

Product

Resources

About

Risk association of HbA_1c variability with chronic kidney disease and cardiovascular disease in type 2 diabetes: prospective analysis of the Hong Kong Diabetes Registry