TY - JOUR
T1 - Visit-to-visit glycated hemoglobin A1c variability in adults with type 2 diabetes
T2 - a systematic review and meta-analysis
AU - Qu, Furong
AU - Shi, Qingyang
AU - Wang, Yang
AU - Shen, Yanjiao
AU - Zhou, Kaixin
AU - Pearson, Ewan R.
AU - Li, Sheyu
N1 - Funding Information:
This work was supported by grants from the National Key R&D Program of China (No. 2018YFC200100X), the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (Nos. ZYGD18022 and 20HXFH011).
Copyright:
© 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.
PY - 2022/10/5
Y1 - 2022/10/5
N2 - Background: Current practice uses the latest measure of glycated hemoglobin (HbA1c) to facilitate clinical decision-making. Studies have demonstrated that HbA1c variability links the risk of death and complications of diabetes. However, the role of HbA1c variability is unclear in clinical practice. This systematic review summarized the evidence of visit-to-visit HbA1c variability regarding different metrics in micro- and macro-vascular complications and death in people with type 2 diabetes.Methods: We searched PubMed, EMBASE (via OVID), and Cochrane Central Register (CENTRAL, via OVID) for studies investigating the association between HbA1c variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbA1c variability metrics in terms of standard deviation (SD), coefficient of variation (CV), and HbA1c variability score (HVS).Results: In people with type 2 diabetes, the highest quantile of all three HbA1c variability metrics (HbA1c-standard deviation [HbA1c-SD], HbA1c-coefficient of variance [HbA1c-CV], and HVS) is associated with increased risks of all-cause mortality, cardiovascular events, progression to chronic kidney disease, amputation, and peripheral neuropathy. For example, the hazard ratio of HbA1c-SD on all-cause mortality was 1.89 with 95% confidence interval (95% CI) 1.46-2.45 (HbA1c-CV 1.47, 95% CI 1.26-1.72; HVS 1.67, 95% CI 1.34-2.09).Conclusions: High HbA1c variability leads to micro- and macro-vascular complications of type 2 diabetes and related death. People with type 2 diabetes and high HbA1c variability need additional attention and care for the potential adverse outcomes.
AB - Background: Current practice uses the latest measure of glycated hemoglobin (HbA1c) to facilitate clinical decision-making. Studies have demonstrated that HbA1c variability links the risk of death and complications of diabetes. However, the role of HbA1c variability is unclear in clinical practice. This systematic review summarized the evidence of visit-to-visit HbA1c variability regarding different metrics in micro- and macro-vascular complications and death in people with type 2 diabetes.Methods: We searched PubMed, EMBASE (via OVID), and Cochrane Central Register (CENTRAL, via OVID) for studies investigating the association between HbA1c variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbA1c variability metrics in terms of standard deviation (SD), coefficient of variation (CV), and HbA1c variability score (HVS).Results: In people with type 2 diabetes, the highest quantile of all three HbA1c variability metrics (HbA1c-standard deviation [HbA1c-SD], HbA1c-coefficient of variance [HbA1c-CV], and HVS) is associated with increased risks of all-cause mortality, cardiovascular events, progression to chronic kidney disease, amputation, and peripheral neuropathy. For example, the hazard ratio of HbA1c-SD on all-cause mortality was 1.89 with 95% confidence interval (95% CI) 1.46-2.45 (HbA1c-CV 1.47, 95% CI 1.26-1.72; HVS 1.67, 95% CI 1.34-2.09).Conclusions: High HbA1c variability leads to micro- and macro-vascular complications of type 2 diabetes and related death. People with type 2 diabetes and high HbA1c variability need additional attention and care for the potential adverse outcomes.
KW - Visit-to-visit HbA1c variability
KW - Type 2 diabetes
KW - Macrovascular complications
KW - All-cause mortality
KW - Glycated hemoglobin
UR - http://www.scopus.com/inward/record.url?scp=85142645229&partnerID=8YFLogxK
U2 - 10.1097/CM9.0000000000002073
DO - 10.1097/CM9.0000000000002073
M3 - Review article
C2 - 35952315
SN - 0366-6999
VL - 135
SP - 2294
EP - 2300
JO - Chinese medical journal
JF - Chinese medical journal
IS - 19
ER -
