Prognostic impact of visit-to-visit glycemic variability on the risks of major adverse cardiovascular outcomes and hypoglycemia in patients with different glycemic control and type 2 diabetes.
机构：[1]Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078 Changsha, People’s Republic of China[2]Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078 Changsha, People’s Republic of China[3]Data Analysis Technology Lab, School of Mathematics and Statistics, Henan University, 475004 Kaifeng, People’s Republic of China[4]Department of Laboratory Medicine, National Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China四川大学华西医院
The prognostic impact of visit-to-visit glycemic variability on clinical outcomes in patients with different glycemic control and type 2 diabetes remains obscure. We investigated glucose variability and clinical outcomes for patients in the groups of Good glycemic control (GC), Insufficient glycemic control (IC), and Poor glycemic control (PC) in a prospective cohort study.
By using data from Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE), 930 patients were enrolled from 61 centers in China and grouped into GC, IC, and PC according to their glycated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG). Visit-to-visit glycemic variability was defined using the coefficient of variation (CV) of five measurements of HbA1c and FPG taken 3-24 months after treatment. Multivariable Cox proportional hazards models were employed to estimate adjusted hazard ratio (aHR).
Among 930 patients in the intensive glucose control, 82, 538, and 310 patients were assigned to GC, IC, and PC, respectively. During the median of 4.8 years of follow-up, 322 patients were observed hypoglycemia and 244 patients experienced major adverse cardiovascular events (MACE). The CV of HbA1c and FPG was significantly lower for GC (6.0 ± 3.8, 11.2 ± 6.2) than IC (8.3 ± 5.6, 17.9 ± 10.6) and PC (9.5 ± 6.3, 19.3 ± 10.8). High glycemic variability was associated with a greater risk of MACE (aHR: 2.21; 95% confidence interval (CI): 1.61-3.03; p < 0.001) and hypoglycemia (aHR: 1.36; 95% CI: 1.04-1.79; p = 0.025) than low glycemic variability in total patients. The consistent trend was also found in subgroups of GC, IC, and PC.
This prospective cohort study showed that glycemic variability was significantly lower for GC than IC and PC. Furthermore, glycemic variability was associated with the risk of MACE and hypoglycemia in total patients and subgroups of different glycemic control.
基金：
National Key
Research and Development Program (No. 2016YFC0905000),
National Natural Science Foundation of China (Nos. 81522048,
81573511, and 81874329) and the Innovation Driven Project of
Central South University (No. 2016CX024).
语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2019]版：
大类|2 区医学
小类|3 区内分泌学与代谢
最新[2023]版：
大类|3 区医学
小类|3 区内分泌学与代谢
第一作者：
第一作者机构：[1]Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078 Changsha, People’s Republic of China[2]Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078 Changsha, People’s Republic of China
共同第一作者：
通讯作者：
通讯机构：[1]Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078 Changsha, People’s Republic of China[2]Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078 Changsha, People’s Republic of China
推荐引用方式(GB/T 7714)：
Sun Bao,He Fazhong,Gao Yongchao,et al.Prognostic impact of visit-to-visit glycemic variability on the risks of major adverse cardiovascular outcomes and hypoglycemia in patients with different glycemic control and type 2 diabetes.[J].Endocrine.2019,64(3):536-543.doi:10.1007/s12020-019-01893-1.
APA：
Sun Bao,He Fazhong,Gao Yongchao,Zhou Jiecan,Sun Lei...&Zhang Wei.(2019).Prognostic impact of visit-to-visit glycemic variability on the risks of major adverse cardiovascular outcomes and hypoglycemia in patients with different glycemic control and type 2 diabetes..Endocrine,64,(3)
MLA：
Sun Bao,et al."Prognostic impact of visit-to-visit glycemic variability on the risks of major adverse cardiovascular outcomes and hypoglycemia in patients with different glycemic control and type 2 diabetes.".Endocrine 64..3(2019):536-543
