Visit-to-visit variability of glycated albumin was associated with incidence or progression of lower extremity atheroscl
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ORIGINAL INVESTIGATION
Cardiovascular Diabetology Open Access
Visit‑to‑visit variability of glycated albumin was associated with incidence or progression of lower extremity atherosclerotic disease Yun Shen1,2†, Dongjun Dai1†, Jingyi Lu1, Yufei Wang1, Wei Zhu1, Yuqian Bao1, Gang Hu2* and Jian Zhou1*
Abstract Background: The aim of this study was to investigate the association of visit-to-visit variability of hemoglobin A1c (HbA1c) and glycated albumin (GA) with the risk of lower extremity atherosclerotic disease (LEAD). Method: We performed a prospective cohort study of 436 patients with type 2 diabetes (258 men and 178 women) with at least 3 measurements of HbA1c and GA prior to baseline investigation from the Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital. Different HbA1c and GA variability markers were calculated. Multivariable Cox proportional hazard regression models were used to demonstrate the association between visit-to-visit HbA1c and GA variability and the risk of incident or progressive LEAD. Results: During a mean follow-up period of 3.77 years, 112 participants developed LEAD. Multivariate-adjusted hazard ratios (HRs) of LEAD across tertiles of GA-CV values were 1.00, 1.06 (95% confidence interval [CI] 0.65–1.75), and 1.71 (95% CI 1.07–2.73) (P for trend = 0.042), respectively. When we used GA-VIM and GA-ARV values as exposures, similar positive associations with the risk of LEAD primary were found. Multivariate-adjusted HRs of LEAD for each 1 unit increase in GA-CV, GA-VIM and GA-ARV were 1.03 (95% CI 1.01–1.06), 1.32 (95% CI 1.03–1.69), and 1.07 (95%CI 1.01–1.15), respectively. However, there was no significant association between visit-to-visit variability of HbA1c and the risk of LEAD. Conclusions: Visit-to-visit variability of GA may be an optimal biomarker in relation to LEAD risk among patients with type 2 diabetes. Keywords: Glycated albumin, Glycemic variability, Lower extremity atherosclerotic disease Background Lower extremity atherosclerotic disease (LEAD) is one of the life-threatening complications of diabetes. LEAD and the subsequent vascular occlusion, gangrene and lower extremity amputation seriously affect the quality of life of *Correspondence: [email protected]; [email protected] † Yun Shen and Dongjun Dai contributed equally to this work 1 Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China 2 Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
patients and increase the economic burden [1, 2]. However, the onset of LEAD is insidious, and 40% of patients are asymptomatic. Therefore, early identification and intervention to delay the progression of LEAD can effectively reduce the risk of the above serious outcomes. Among patients with diabetes, long-term exposure
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