Variability in hemoglobin A1c predicts all-cause mortality in patients with type 2 diabetes

Ma, Wen-Ya; Li, Chung‐Yi; Pei, Dee; Hsia, Te-Lin; Lu, Kuo‐Cheng; Tsai, Li-Yu; Wei, Jung-Nan; Su, Ching-Chieh

doi:10.1016/j.jdiacomp.2012.03.028

Cited by 56 publications

(72 citation statements)

References 28 publications

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“…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).…”

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confidence: 99%

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

et al. 2015

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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

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Section: Data Synthesis and Analysismentioning

confidence: 99%

Section: Type 2 Diabetesmentioning

confidence: 99%

Section: Type 2 Diabetesmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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

et al. 2015

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The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study

et al. 2015

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Aims/hypothesis The aim of this study was to assess gender differences in mortality and morbidity during 13 follow-up years after 6 years of structured personal care in patients with type 2 diabetes mellitus. Methods In the Diabetes Care in General Practice (DCGP) multicentre, cluster-randomised, controlled trial (ClinicalTrials.gov registration no. NCT01074762), 1,381 patients newly diagnosed with type 2 diabetes were randomised to receive 6 years of either structured personal care or routine care. The intervention included regular follow-up, individualised goal setting and continuing medical education of general practitioners participating in the intervention. Patients were re-examined at the end of intervention. This observational analysis followed 970 patients for 13 years thereafter using national registries. Outcomes were all-cause mortality, incidence of diabetes-related death, any diabetes-related endpoint, myocardial infarction, stroke, peripheral vascular disease and microvascular disease. Results In women, but not men, a lower HR for structured personal care vs routine care emerged for any diabetes-related endpoint (0.65, p=0.004, adjusted; 73.4 vs 107.7 events per 1,000 patient-years), diabetes-related death (0.70, p=0.031; 34.6 vs 45.7), all-cause mortality (0.74, p = 0.028; 55.5 vs 68.5) and stroke (0.59, p=0.038; 15.6 vs 28.9). This effect was different between men and women for diabetesrelated death (interaction p=0.015) and all-cause mortality (interaction p=0.005). Conclusions/interpretation Compared with routine care, structured personal diabetes care reduced all-cause mortality and diabetes-related death in women but not in men. This gender difference was also observed for any diabetes-related outcome and stroke but was not statistically significant after extensive multivariate adjustment. These observational results from a post hoc analysis of a randomised controlled trial cannot be explained by intermediate outcomes like HbA 1c alone, but involves complex social and cultural issues of gender. There is a need to rethink treatment schemes for both men and women to gain benefit from intensified treatment efforts.

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Serum fibroblast growth factor 21 is predictive of combined cardiovascular morbidity and mortality in patients with type 2 diabetes at a relatively short-term follow-up

Lenart-Lipińska

Matyjaszek‐Matuszek

Gernand³

et al. 2013

Diabetes Research and Clinical Practice

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Variability in hemoglobin A1c predicts all-cause mortality in patients with type 2 diabetes

Cited by 56 publications

References 28 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

The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study

Serum fibroblast growth factor 21 is predictive of combined cardiovascular morbidity and mortality in patients with type 2 diabetes at a relatively short-term follow-up

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