Association of the average rate of change in HbA(1c) with severe adverse events: a longitudinal evaluation of audit data from the Bavarian Disease Management Program for patients with type 2 diabetes mellitus

作者：Bonke Florian C; Donnachie Ewan; Schneider Antonius; Mehring Michael^*

来源：Diabetologia, 2016, 59(2): 286-293.

DOI：10.1007/s00125-015-3797-z

• Disease management programme
• HbA(1c) variability
• Health services research
• Severe adverse events
• Type 2 diabetes mellitus

Aims/hypothesis In patients with type 2 diabetes mellitus, the effects of HbA(1c) variability on macrovascular events remain uncertain. The present investigation evaluates the association of HbA(1c) variability with non-fatal cardiovascular events, emergency admissions and episodes of severe hypoglycaemia in a cohort of patients newly started on insulin therapy.
Methods HbA(1c) variability was defined as the rate of change in values between observations. The medical records of 406,356 patients enrolled in a disease management programme for type 2 diabetes mellitus were analysed to identify a cohort of 13,777 patients with observed transition to insulin therapy. The cohort was observed for a period of at least 5 years. Cox regression models were applied to quantify the association of HbA(1c) variability with the events of interest.
Results The models reveal a significant non-linear association between HbA(1c) variability and the risk of experiencing myocardial infarction, stroke and hypoglycaemia. The lowest risk is seen with a variability of approximately 0.5% (5.5 mmol/mol) per quarter. Using Cox models to predict survival curves for the cohort with hypothetical HbA(1c) variability of 0.5% 5.5 mmol/mol) and 1.5% (16.4 mmol/mol) per quarter, the proportion experiencing myocardial infarction within 2 years increases significantly from 1% to 10%. The proportion experiencing stroke increases from 1% to 29%, hypoglycaemia from 2% to 24% and the risk of emergency admission from 2% to 21%.
Conclusions/interpretation In patients newly started on insulin therapy, rapid and higher HbA(1c) variability is associated with an increased risk of myocardial infarction, stroke, severe hypoglycaemia and emergency admission.

• 出版日期2016-2