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A1c Levels & CV Events Modestly Related in Type 2 Diabetes

Researchers seek link between glycemic control and new CV events and mortality…

The findings, based on 1,687 adults, also revealed about a 16% increased risk for all-cause mortality with every 1% increase in A1C levels among diabetes patients with and without vascular disease. There was no difference in relationship among people with or without clinical manifestation of vascular disease, according to the researchers.

Jan Westerink, MD, PhD, of the University Medical Centre Utrecht in the Netherlands, and colleagues evaluated data from the Second Manifestations of Arterial Disease (SMART) study on 1,687 adults (mean age, 60.2 years) with type 2 diabetes, with and without vascular disease, to determine the relationship between glycemic control and new CV events and mortality. Follow-up was conducted for a median of 6.1 years.

During follow-up, 293 participants experienced a new CV event, and 189 died as a result of vascular disease; 340 participants died of all causes.

There was a non-significant relationship between CV events and higher levels of HbA1c in all participants (HR = 1.06; 95% CI, 0.97-1.17). Similarly, no relationship was found for participants with type 2 diabetes and vascular disease at baseline (HR = 1.03; 95% CI, 0.93-1.15). A strong relationship was found between HbA1c levels and CV events in participants without vascular disease (HR = 1.27; 95% CI, 1.06-1.51).

There was a 16% higher risk for all-cause mortality with each 1% increase in HbA1c in participants with diabetes and manifest vascular disease (HR = 1.16; 95% CI, 1.06-1.28); a similar relationship was found among those without vascular disease (HR = 1.13; 95% CI, 0.97-1.31).

“These cohort data do not necessarily preclude the possibility of clinical benefit of more stringent glycemic control on macro- and especially microvascular complications in these patients,” Westerink added in an interview. “However, when the primary focus is a reduction of the risk for macrovascular disease in patients with type 2 diabetes (with vascular disease) by means of improving glycemic control, one should take into account the absence of the relation between glycemic control and clinical outcome in this study. Further research on the best approach for risk reduction in these very high-risk patients is needed, including evidence to support clinicians in predicting which exact patient with type 2 diabetes would probably benefit most from improved glycemic control.”

Practice Pearls:

  • There was a nonsignificant relationship between CV events and higher levels of HbA1c in all participants.
  • A strong relationship was found between HbA1c levels and CV events in participants without vascular disease.
  • There was a 16% higher risk for all-cause mortality with each 1% increase in HbA1c in participants with diabetes and manifest vascular disease); a similar relationship was found among those without vascular disease.

Kranenburg G, et al. Diabetes Care. 2015;doi:10.2337/dc15-0493.