Predictions of diabetes complications and mortality using hba1c variability: a 10-year observational cohort study
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ORIGINAL ARTICLE
Predictions of diabetes complications and mortality using hba1c variability: a 10‑year observational cohort study Sharen Lee1 · Tong Liu2 · Jiandong Zhou3 · Qingpeng Zhang3 · Wing Tak Wong4 · Gary Tse2 Received: 13 June 2020 / Accepted: 9 September 2020 © Springer-Verlag Italia S.r.l., part of Springer Nature 2020
Abstract Introduction Emerging evidence suggests that HbA1c variability, in addition to HbA1c itself, can be used as a predictor for mortality. The present study aims to examine the predictive power of mean HbA1c and HbA1c variability measures for diabetic complications as well as mortality. Methods The retrospective observational study analyzed diabetic patients who were prescribed insulin at outpatient clinics of the Prince of Wales Hospital and Shatin Hospital, Hong Kong, from 1 January to 31 December, 2009. Standard deviation (SD), root mean square (RMS), and coefficient of variation were used as measures of HbA1c variability. The primary outcomes were all-cause and cardiovascular mortality. Secondary outcomes were diabetes-related complications. Results The study cohort consists of 3424 patients, including 3137 patients with at least three HbA1c measurements. The low mean HbA1c subgroup had significantly shorter time-to-death for all-cause mortality (P 3.5 g/d, or albumin/creatinine ratio > 30 mg/mmol. Sudden cardiac death was defined as the occurrence of ventricular tachyarrhythmia or non-specific cardiac arrest. Patients with established events before recruitment for a given outcome were excluded. For other outcomes, if there were no events, then these patients were included. Cardiovascular mortality was recorded using the International Classification of Diseases Tenth Edition (ICD-10) coding, while the remaining outcomes were documented in CDARS under ICD-9 codes. Furthermore, baseline clinical details include: (1) age, (2) sex, (3) specific comorbidities (chronic renal disease [CKD], chronic obstructive pulmonary disease [COPD], chronic liver disease [CLD], heart failure [HF], ischemic heart disease [IHD], hypertension, myocardial infarction [MI], stroke). To capture the episodic occurrence of diseases, such as MI, or the initiation of chronic conditions, such as hypertension, data on patient diagnosis from January 1, 1999, to December 31, 2008, were extracted. The patient’s age is defined as age on January 1, 2009. Additionally, the dosing regimen of antidiabetic and cardiovascular medications prescribed was extracted. The mean daily dose, which is the product between the daily dosing frequency and dosage, is reported for each drug class. The classes of antidiabetic agents include: (1) insulin, (2) sulphonylurea, (3) biguanide, (4) alpha-glucosidase inhibitor, (5) thiazolidinedione, (6) meglitinide, (7) dipeptidyl peptidase-4 inhibitor, (8) glucagon-like peptide receptor-1 agonist. The cardiovascular medications include: (1) angiotensinogen-convertingenzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), (2) beta-adrenergic receptor blocker, (3) calcium channel blocker
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