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- Title
Mean HbA<sub>1c</sub> and mortality in diabetic individuals with heart failure: a population cohort study.
- Authors
Elder, Douglas H. J.; Singh, Jagdeep S. S.; Levin, Daniel; Donnelly, Louise A.; Choy, Anna-Maria; George, Jacob; Struthers, Allan D.; Doney, Alex S. F.; Lang, Chim C.
- Abstract
Aims Controversy exists regarding the importance of glycaemic control in patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) based on conflicting reports using single baseline glycosyated haemoglobin (HbA1c). Using the time-weighted mean of serial HbA1c measurements has been found to be a better predictor of diabetic complications as it reflects the glycaemic burden for that individual over time. We therefore sought to confirm this in a large cohort of patients with T2DM and incident CHF. Methods and results A time-weighted mean HbA1c was calculated using all HbA1c measurements following CHF diagnosis. Patients were grouped into five categories of HbA1c (≤6.0%, 6.1 -7.0%, 7.1 -8.0%, 8.1 -9.0%, and >9.0%). The relationship between time-weighted mean HbA1c and all-cause death after CHF diagnosis was assessed. A total of 1447 patients with T2DM met the study criteria. During a median follow-up of 2.8 years, there were 826 (57.1%) deaths, with a crude death rate of 155 deaths per 1000 person-years [95% confidence interval (CI) 144 - 166]. A Cox regression model, adjusted for all significant predictors, with the middle HbA1c category (7.1 - 8.0%) as the reference, showed a U-shaped relationship between HbA1c and outcome [HbA1c <6.0%, hazard ratio (HR) 2.5, 95% CI 1.8-3.4; HbA1c 6.1 -7.0%, HR 1.4, 95% 1.1 - 1.7; HbA1c 8.1 -9.0%, HR 1.3, 95% CI 1.0 - 1.6; and HbA1c >9.0%, HR 1.8, 95% CI 1.4 - 2.3]. Further analysis revealed a protective effect of insulin sensitizers (i.e. metformin) (HR 0.7, 95% CI 0.61 - 0.93) but not other drug classes. Conclusions In patients with T2DM and CHF, our study shows a U-shaped relationship between HbA1c and mortality, with the lowest risk in patients with modest glycaemic control (HbA1c 7.1 - 8.0%) and those treated with insulin sensitizers.
- Publication
European Journal of Heart Failure. Supplements, 2016, Vol 18, Issue 1, p94
- ISSN
1567-4215
- Publication type
Article
- DOI
10.1002/ejhf.455