The combined effect of visit-to-visit variability in HbA1c and systolic blood pressure on the incidence of cardiovascular events in patients with type 2 diabetes

Takao, Toshiko; Matsuyama, Yutaka; Suka, Machi; Yanagisawa, Hiroyuki; Iwamoto, Yasuhiko

doi:10.1136/bmjdrc-2015-000129

Cited by 33 publications

(32 citation statements)

References 30 publications

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“…and blood lipids of males in this age-group have worse control conditions, and women may be easily affected by physiological cycle. As in previous reports (19,(22)(23)(24), gender differences were noted in the relationship between HbA1c and age. It is possible that this finding is related to lower hemoglobin levels in menstruating women with more rapid erythrocyte turnover, as suggested previously (19).…”

Section: Discussionsupporting

confidence: 56%

Association between glycated hemoglobin A1c levels with age and gender in Chinese adults with no prior diagnosis of diabetes mellitus

Liu

Xiang

et al. 2016

Biomedical Reports

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The present cross-sectional study consisted of 18,265 Chinese patients not previously diagnosed with diabetes mellitus, and who underwent physical examination at the Third People's Hospital of Shenzhen between June 2014 and May 2015 (mean patient age, 51.312±15.252 years). The study was composed of 11,770 males and 6,495 females. The aim was to investigate the association between glycated hemoglobin A1c (HbA1c) levels, gender and age. HbA1c values were measured using a Bio-Rad VARIANT™ II HbA1c Reorder Pack. All data was collected for analysis of the HbA1c levels in different gender and age groups, in order to investigate the association between HbA1c levels and age. Analysis of the 18,265 total cases and 16,734 cases with HbA1c levels <6.5%, demonstrated a positive correlation between levels of HbA1c and patient age. Linear regression for patient age and HbA1c levels demonstrated that HbA1c (%) = 0.020 × age (years) + 4.523 (r=0.369, P<0.0001) and HbA1c (%) = 0.014 × age (years) + 4.659 (r=0.485, P<0.0001), respectively. HbA1c levels of the male group were significantly higher than those of the female group (P<0.0001). Furthermore, in different gender groups, HbA1c levels gradually rose with increasing age. Therefore, HbA1c levels are associated with age and gender in Chinese populations, and this should be considered when selecting HbA1c as a criterion for future diabetes screening.

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Section: Discussionsupporting

confidence: 56%

Association between glycated hemoglobin A1c levels with age and gender in Chinese adults with no prior diagnosis of diabetes mellitus

Liu

Xiang

et al. 2016

Biomedical Reports

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“…Full‐text versions of the remaining 73 articles were retrieved and singularly examined. Ultimately, 47 studies were excluded and, of the remaining 26 papers that were included, 22 were selected for quantitative analysis . Secondary endpoints (i.e.…”

Section: Resultsmentioning

confidence: 99%

Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis

Chiriacò

Pateras

Virdis

et al. 2019

Diabetes Obesity Metabolism

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Aim To investigate the associations of blood pressure variability (BPV), expressed as long‐term (visit‐to‐visit) and short‐term (ambulatory blood pressure monitoring [ABPM] and home blood pressure monitoring [HBPM]) and all‐cause mortality, major adverse cardiovascular events (MACEs), extended MACEs, microvascular complications (MiCs) and hypertension‐mediated organ damage (HMOD) in adult patients with type 2 diabetes. Materials and methods PubMed, Medline, Embase, Cinahl, Web of Science, http://clinicaltrials.gov and grey literature databases were searched for studies including patients with type 2 diabetes, at least one variable of BPV (visit‐to‐visit, HBPM, ABPM) and evaluation of the incidence of at least one of the following outcomes: all‐cause mortality, MACEs, extended MACEs and/or MiCs and/or HMOD. The extracted information was analyzed using random effects meta‐analysis and meta‐regression. Results Data from a total of 377 305 patients were analyzed. Systolic blood pressure (SBP) variability was associated with a significantly increased risk of all‐cause mortality (HR 1.12, 95% CI 1.04–1.21), MACEs (HR 1.01, 95% CI 1.04–1.17), extended MACEs (HR 1.07, 95% CI 1.03–1.11) and MiCs (HR 1. 12, 95% CI 1.01–1.24), while diastolic blood pressure was not. Associations were mainly driven from studies on long‐term SBP variability. Qualitative analysis showed that BPV was associated with the presence of HMOD expressed as carotid intima‐media thickness, pulse wave velocity and left ventricular hypertrophy. Results were independent of mean blood pressure, glycaemic control and serum creatinine levels. Conclusions Our results suggest that BPV might provide additional information rather than mean blood pressure on the risk of cardiovascular disease in patients with type 2 diabetes.

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“…We previously reported that HbA1c variability was a predictor of CVD incidence and all‐cause mortality in type 2 diabetes patients independent of mean HbA1c level. Thus, these adverse events might be influenced by both short‐term glucose excursions and long‐term glycemic variability in type 2 diabetes patients.…”

Section: Discussionmentioning

confidence: 96%

Impact of postprandial hyperglycemia at clinic visits on the incidence of cardiovascular events and all‐cause mortality in patients with type 2 diabetes

Takao

Suka

Yanagisawa

et al. 2017

J of Diabetes Invest

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Aims/IntroductionWe evaluated the impact of postprandial hyperglycemia at clinic visits on the incidence of cardiovascular diseases (CVD) and all‐cause mortality independently of mean glycosylated hemoglobin in type 2 diabetes patients in a real‐world setting.Materials and MethodsThe present retrospective observational cohort study included 646 type 2 diabetes patients. All of the participants had their initial consultations at the Institute for Diabetes Care and Research, Asahi Life Foundation affiliated Marunouchi Hospital, Tokyo, Japan, during the period from 1995 to 1996, visited the clinic ≥4 times, had their 2‐h post‐breakfast blood glucose (2h‐PBBG) levels measured and were followed up for ≥1 year. The 646 patients were followed up for survival. Of the 646 patients, 618 had no history of CVD at the first visit and had measured 2h‐PBBG until the first CVD onset or censorings. These two cohorts were followed up through June 2012, and subsequently questionnaires were mailed. Multivariate Cox proportional hazard models were used to evaluate the risk of CVD incidence and death.Results CVD occurred in 78 patients, and 56 patients died. The median follow‐up periods of the CVD cohort and the mortality cohort were 15.6 and 15.9 years, respectively. The mean 2h‐PBBG is a significant predictor of the CVD incidence and all‐cause mortality after adjusting for the mean glycosylated hemoglobin, the number of 2h‐PBBG measurements, age, sex and classical risk factors.ConclusionsPostprandial hyperglycemia represented by the mean level of 2h‐PBBG at clinic visits is associated with CVD incidence and all‐cause mortality independently of the mean glycosylated hemoglobin level in type 2 diabetes patients. Prospective interventional trials are warranted to confirm the present findings.

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The combined effect of visit-to-visit variability in HbA1c and systolic blood pressure on the incidence of cardiovascular events in patients with type 2 diabetes

Cited by 33 publications

References 30 publications

Association between glycated hemoglobin A1c levels with age and gender in Chinese adults with no prior diagnosis of diabetes mellitus

Association between glycated hemoglobin A1c levels with age and gender in Chinese adults with no prior diagnosis of diabetes mellitus

Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis

Impact of postprandial hyperglycemia at clinic visits on the incidence of cardiovascular events and all‐cause mortality in patients with type 2 diabetes

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