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HbA1c Variability and Mortality in Patients with Type 2 Diabetes

HbA1c variability is a predictor of all-cause mortality….

Researchers evaluated the association between HbA1c variability and mortality due to all causes, cancer, and non-cancer in patients with type 2 diabetes independent of mean HbA1c levels.

The study enrolled 754 patients with type 2 diabetes who first visited the hospital between 1995 and 1996, had been followed for at least 2 years, and had undergone four or more HbA1c determinations. Patients were followed through June 2012. The standard deviation (SD) or coefficient of variation (CV) was used as a measure of HbA1c variability. Risk of death was evaluated by multivariate Cox proportional hazard models.

Through June 2012, 63 patients died. Hazard ratios (HRs) for all-cause mortality and non-cancer mortality including cardiovascular diseases (CVD) increased across tertiles of both HbA1cSD and HbA1cCV. HRs for cancer mortality did not increase across tertiles of either HbA1cSD or HbA1cCV. Using a stepwise regression method, both HbA1cSD and HbA1cCV predicted all-cause mortality, especially non-cancer mortality. In contrast, mean HbA1c predicted cancer mortality.

Researchers concluded that, HbA1c variability is a predictor of all-cause mortality, especially non-cancer mortality including CVD, in patients with type 2 diabetes, independent of mean HbA1c level. In contrast, mean HbA1c, but not HbA1c variability, might predict cancer mortality.

Practice Pearls:
  • This was a small study of 754 patients.
  • HbA1c variability by both measures predicted all-cause mortality, and mean HbA1c predicted cancer mortality.

Journal of Diabetes and Its Complications.2014 Jul 01;28(4)494-499, T Takao, Y Matsuyama, H Yanagisawa, M Kikuchi, S Kawazu