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- Title
Mean HbA1c 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
<bold>Aims: </bold>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.<bold>Methods and Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
UNITED Kingdom; MORTALITY; DIABETES; HEART failure patients; DIABETES complications; GLYCOSYLATED hemoglobin; GLYCEMIC control; COHORT analysis; HYPOGLYCEMIC agents; METFORMIN; TYPE 2 diabetes complications; HEART failure; LONGITUDINAL method; TYPE 2 diabetes; HEALTH outcome assessment; PATIENT monitoring; RISK assessment; PROPORTIONAL hazards models; DISEASE complications; DIAGNOSIS
- Publication
European Journal of Heart Failure, 2016, Vol 18, Issue 1, p94
- ISSN
1388-9842
- Publication type
journal article
- DOI
10.1002/ejhf.455