scholarly journals Association of Mean and Variability of HbA1c with Heart Failure in Patients with Type 2 Diabetes

2021 ◽  
Vol 10 (7) ◽  
pp. 1401
Author(s):  
You-Ting Lin ◽  
Wei-Lun Huang ◽  
Hung-Pin Wu ◽  
Man-Ping Chang ◽  
Ching-Chu Chen
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Hba1c Level ◽  
Care Program ◽  
Good Glycemic Control ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Models ◽  
Hba1c Variability

Heart failure (HF) is a common presentation in patients with type 2 diabetes mellitus (T2DM). Previous studies revealed that the HbA1c level is significantly associated with HF. However, little is known about the association between HbA1c variability and HF. We aimed to evaluate the association of mean and variability of HbA1c with HF in patients with T2DM. Using Diabetes Share Care Program data, patients with T2DM who had mean HbA1c (HbA1c-Mean), and HbA1c variability (tertiles of HbA1c-SD and HbA1c-adjSD) within 12–24 months during 2001–2008 were included. The cutoffs of HbA1c-Mean were set at <7%, 7–7.9%, and ≥8%. Hazard ratios (HRs) for HF during 2008–2018 were estimated using Cox proportional hazard models. A total of 3824 patients were included, of whom 315 patients developed HF during the observation period of 11.72 years. The associated risk of HF increased with tertiles of HbA1c variability and cutoffs of HbA1c-Mean. In mutually adjusted models, HbA1c-Mean showed a consistent dose-response association with HF, while the association of HbA1c variability with HF disappeared. Among patients with HbA1c-Mean <7%, the associated risk of HF in patients with HbA1c variability in tertile 3 was comparable to patients with HbA1c-Mean ≥8%. In conclusion, mean HbA1c was an independent predictor of HF and not explained by HbA1c variability. In addition to absolute HbA1c level, targeting on stability of HbA1c in patients with good glycemic control was also important for the development of HF in patients with T2DM.

scholarly journals Glycated hemoglobin variability, mean HbA1c and heart failure in patients with type 2 diabetes

2020 ◽  
Author(s):  
You-Ting Lin ◽  
Wei-Lun Huang ◽  
Hung-Pin Wu ◽  
Man-Ping Chang ◽  
Ching-Chu Chen
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Hba1c Level ◽  
Proportional Hazards ◽  
Care Program ◽  
Cox Proportional Hazards ◽  
Hemoglobin Variability ◽  
Cox Proportional Hazards Models ◽  
Hba1c Variability

Abstract Background: Heart failure (HF) is a common presentation in patients with type 2 diabetes mellitus (T2DM). Previous studies revealed that HbA1c level is significantly associated with HF. However, little is known about the association between HbA1c variability and HF. We aimed to evaluate the association of HbA1c variability and mean HbA1c with HF in patients with T2DM. Methods: Using Diabetes Share Care Program data, patients with T2DM had mean HbA1c (HbA1c-Mean), HbA1c variability (tertiles of HbA1c-SD and HbA1c-adjSD) within 12-24 months during 2001-2008 were included. The cutoffs of HbA1c-Mean were set at <7%, 7-7.9%, and ≥8%. Hazard ratios (HRs) for HF during 2008-2018 were estimated using Cox proportional hazards models. Results: A total of 3824 patients were included, of whom 315 patients developed HF during the 11.72 years observation period. The associated risk of HF increased with tertiles of HbA1c variability and cutoffs of HbA1c-Mean. In mutually adjusted models, HbA1c-Mean showed a consistent dose-response association with HF, while the association of HbA1c variability with HF disappeared. Among patients with HbA1c-Mean < 7%, the associated risk of HF in patients with HbA1c variability in tertile 3 was comparable to patients with HbA1c-Mean ≥8%. Conclusions: Mean HbA1c was an independent predictor of HF and not explained by HbA1c variability. In addition to absolute HbA1c level, targeting on stability of HbA1c in patients with well glycemic control was also important for the development of HF in patients with T2DM.

scholarly journals Long-term HbA1c variability and the development and progression of diabetic retinopathy in subjects with type 2 diabetes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Han Ul Kim ◽  
Sung Pyo Park ◽  
Yong-Kyu Kim
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Hba1c Level ◽  
Cox Proportional Hazards ◽  
Progression Rate ◽  
Absolute Increase ◽  
Hba1c Variability ◽  
Hba1c Levels

AbstractThis study aimed to investigate whether long-term HbA1c variability is associated with the development and progression of diabetic retinopathy (DR) in subjects with type 2 diabetes. We retrospectively reviewed 434 type 2 diabetes subjects without DR who underwent regular DR screening. We reviewed fundus findings, collected HbA1c levels, and calculated the coefficient of variation (CV) and average real variability (ARV) of each subject’s HbA1c level. DR was developed in 55 subjects and progressed to moderate nonproliferative DR or worse DR in 23 subjects. On Cox proportional hazards regression analysis, HbA1c ARV, but not HbA1c CV, was significantly associated with DR development. However, the association between HbA1c variability and the DR progression rate to moderate nonproliferative DR or worse DR was not significant. The inter-visit HbA1c difference value on consecutive examination predicted DR development well and more careful screening for DR is needed for those with an absolute value change of 2.05%, an absolute increase of 1.75%, and an absolute decrease of 1.45% in HbA1c levels on consecutive examination. These results indicate that long-term glucose variability measured by HbA1c ARV might be an independent risk factor for DR development in addition to the mean HbA1c level in early diabetic subjects.

scholarly journals Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus

2021 ◽  
Author(s):  
Arnaud D. Kaze ◽  
Prasanna Santhanam ◽  
Sebhat Erqou ◽  
Rexford S. Ahima ◽  
Alain Bertoni ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Microvascular Disease ◽  
Hazard Ratio ◽  
Unique Identifier ◽  
Hazard Ratios ◽  
Incident Heart Failure

Background Microvascular disease (MVD) is a potential contributor to the pathogenesis of diabetes mellitus–related cardiac dysfunction. However, there is a paucity of data on the link between MVD and incident heart failure (HF) in type 2 diabetes mellitus. We examined the association of MVD with incident HF in adults with type 2 diabetes mellitus. Methods and Results A total of 4095 participants with type 2 diabetes mellitus and free of HF were assessed for diabetes mellitus–related MVD including nephropathy, retinopathy, or neuropathy at baseline in the Look AHEAD (Action for Health in Diabetes) study. Incident HF events were prospectively assessed and adjudicated using hospital and death records. Cox models were used to generate hazard ratios and 95% CIs for HF. Of 4095 participants, 34.8% (n=1424) had MVD, defined as the presence of ≥1 of nephropathy, retinopathy, or neuropathy at baseline. Over a median of 9.7 years, there were 117 HF events. After adjusting for relevant confounders, participants with MVD had a 2.5‐fold higher risk of incident HF than those without MVD (hazard ratio, 2.54; 95% CI, 1.73–3.75). This association remained significant after additional adjustment for interval development of coronary artery disease (hazard ratio, 2.42; 95% CI, 1.64–3.57). The hazard ratios for HF by type of MVD were 2.22 (95% CI, 1.51–3.27), 1.30 (95% CI, 0.72–2.36), and 1.33 (95% CI, 0.86–2.07) for nephropathy, retinopathy, and neuropathy, respectively. CONCLUSIONS MVD is associated with an excess HF risk in individuals with type 2 diabetes mellitus after adjusting for other known risk factors. Our findings underscore the contribution of MVD to the development of diabetes mellitus–related HF. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00017953.

Abstract 3737: The Association Between Therapy With Insulin Glargine Versus Nph And The Risk Of Myocardial Infarction In Patients With Type 2 Diabetes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mikhail Kosiborod ◽  
Quanwu Zhang ◽  
JoAnne Foody
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Insulin Glargine ◽  
Lower Risk ◽  
Administrative Database ◽  
Medical Claim ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models

Background: Prior studies have demonstrated that insulin glargine produces less hypoglycemia, as compared with NPH. Whether these results translate into better long-term cardiovascular outcomes in patients with Type 2 diabetes is unknown. Methods: Using a national managed care administrative database, we evaluated patients with Type 2 diabetes who were on oral antiglycemic agents within 6 months prior to initiating either insulin glargine (n=15,039) or NPH (n=5,666) and had at least 12 months of subsequent continuous plan enrollment during 03/2001–03/2005. Cox proportional hazard models were used to compare the rate of subsequent myocardial infarction (MI) events (defined by ICD-9 codes) following initiation of glargine vs NPH, after adjusting for demographic characteristics, comorbidities, other medications, insulin adherence and baseline Hemoglobin A1C (A1C). Results: Mean age was 56 years, 49% were women; mean duration of follow up was 24 months. Among patients who had available A1C (n=2514), those in glargine group had higher A1C at baseline vs. NPH (9.3 vs 8.9 respectively, p<0.0001). During the 1 st year following insulin initiation, 8.7% patients in NPH vs. 7.5% in glargine group had at least one medical claim for hypoglycemia (OR=1.17, 95% CI: 1.05–1.31). In unadjusted analysis, the rate of MI events was 4.4% in glargine group vs. 7.7% in the NPH group (p<0.0001). After multivariable adjustment, risk of MI events remained lower in glargine group (HR: 0.78, 95% CI: 0.64–0.95). Although hypoglycemic events were associated with higher MI risk (HR 1.3, 95% CI 1.18–1.44 for each quarter with a medical claim for hypoglycemia during 1 st year of follow up), the association between glargine use and lower risk of MI events remained significant even after adjusting for hypoglycemia (HR: 0.79, 95% CI 0.65–0.96). Conclusion: Initiation of insulin glargine in patients with Type 2 diabetes is associated with lower risk of subsequent MI events, as compared with NPH. Lower rate of hypoglycemia associated with glargine use does not completely account for this difference in outcomes. Further studies are needed to validate these results and provide insights into potential physiologic mechanisms.

Severe Hypoglycemia and Incident Heart Failure among Adults With Type 2 Diabetes

2021 ◽  
Author(s):  
Justin B Echouffo-Tcheugui ◽  
Arnaud D Kaze ◽  
Gregg C Fonarow ◽  
Sam Dagogo-Jack
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Relative Risk ◽  
Cox Regression ◽  
Severe Hypoglycemia ◽  
Medical Assistance ◽  
Hazard Ratios ◽  
Accord Study

Abstract Context The effect of severe hypoglycemia on the incidence of heart failure (HF) is unclear. Objective We evaluated the association of severe hypoglycemia with incident HF among individuals with type 2 diabetes. Methods We included participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Severe hypoglycemia episodes were assessed during the initial 24 months following randomization and defined using two methods: symptomatic, severe hypoglycemic event requiring medical assistance (first definition) or requiring any assistance (second definition). Participants without HF at baseline and during the first 24 months of the study were prospectively followed for incident HF hospitalization. Multivariable Cox regression was used to generate adjusted hazard ratios (HR) for the association of severe hypoglycemia and incident HF. Results Among 9,208 participants (mean age 63 years, 38% female, 62% White), 365 had ≥ 1 episode of severe hypoglycemic. Over a median follow-up of 3 years, there were 249 incident HF events. After multivariable adjustment for relevant confounders, participants with severe hypoglycemia requiring medical assistance had a 68% higher relative risk of incident HF (HR 1.68, 95% CI 1.06-2.66), as compared to individuals who never experienced any episode of hypoglycemia. Severe hypoglycemia requiring any assistance was also associated with a 49% higher relative risk of HF (HR 1.49, 95% CI 1.01-2.21). Conclusion In a large cohort of adults with type 2 diabetes, severe hypoglycemia was independently associated with greater risk of incident HF.

P5006Metformin reduces the risk of hospitalization for heart failure in type 2 diabetes patients: a retrospective cohort analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C H Tseng
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cohort Analysis ◽  
Sensitivity Analyses ◽  
Matched Pair ◽  
Hazard Ratios ◽  
Reimbursement Database ◽  
Diabetes Patients

Abstract Background A beneficial effect of metformin on heart failure requires confirmation. Purpose To investigate whether metformin might affect the risk of heart failure hospitalization in type 2 diabetes patients. Methods Patients with new-onset type 2 diabetes during 1999–2005 were enrolled from the reimbursement database of Taiwan's National Health Insurance and followed until December 31, 2011. Analyses were conducted in a propensity score (PS) matched-pair cohort (42,367 ever users and 42,367 never users) and hazard ratios were estimated by Cox's hazard regression analysis incorporated with the inverse probability of treatment weighting using the PS. Results A total of 1,592 never users and 987 ever users were hospitalized for heart failure for the first time during follow-up, with a respective incidence of 843.34 and 499.18 per 100,000 person-years. The overall hazard ratio was 0.588 (95% confidence interval: 0.543–0.637), and the hazard ratios for the first (<29.13 months), second (29.13–61.63 months), and third (>61.63 months) tertiles of cumulative duration were 1.018 (0.914–1.135), 0.575 (0.511–0.647), and 0.340 (0.297–0.390), respectively. Sensitivity analyses conducted in an unmatched cohort before and after excluding patients who received an irregular refill of metformin or who were treated with incretin-based therapies during follow-up consistently supported such a protective effect of metformin on heart failure. Conclusion Metformin use is associated with a lower risk of hospitalization for heart failure. Acknowledgement/Funding The study was partly supported by the Ministry of Science and Technology (MOST 107-2221-E-002-129-MY3) of Taiwan.

Abstract P316: Alcohol Consumption and Incidence of Atrial Fibrillation and Heart Failure: Prospective Findings From the MOLI-SANI Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Augusto Di Castelnuovo ◽  
Simona Costanzo ◽  
Livia Rago ◽  
Amalia de Curtis ◽  
Mariarosaria Persichillo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Alcohol Consumption ◽  
Alcoholic Beverages ◽  
Hospital Discharges ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Models ◽  
Maximum Protection ◽  
Incident Cases

Introduction: The connection between ethanol intake and atrial fibrillation (AF) or heart failure (HF) remains controversial. Hypothesis: We assessed the hypothesis that alcohol consumption predicts onset of AF or HF. Methods: We analyzed 22,420 (47% men, age≥35) AF or HF-free individuals randomly recruited from the general population included in the MOLI-SANI study, for whom complete data on HF, AF and alcohol were available. The cohort was followed for a median of 4.2 years (91,930 person-years). Alcohol intake was categorized in former, never, occasional (<1 gr/day) drinkers and in four categories of consumers with different intake (Table). Incident cases were identified through linkage to the regional archive of hospital discharges. The end of follow-up was 31/12/2011. Hazard ratios (HRs) were calculated using Cox-proportional hazard models (Table). Results: We identified 546 incident cases of HF and 352 of AF. In comparison with never drinkers, both former or occasional drinkers showed an equal risk of developing HF (Table). Drinking at various amount of alcohol revealed a J-shaped protection against HF, with a 25% (95%CI: 1% to 44%) maximum protection at 2-4 drinks a day, independent from common confounders (Table). Concerning AF, we failed to observe any association of alcohol with onset of it. Very similar results were obtained after restriction of the analyses to only men/women or to type of alcoholic beverages (wine, beer or liquor). Conclusions: Consumption of alcohol in moderation prevent the incidence of heart failure of 25%, whereas it was not associated with development of atrial fibrillation.

The Relationship Between HbA1c Level and Beck Depression Scale in Patients with Heart Failure with Type 2 Diabetes Mellitus

2018 ◽  
Vol 21 (3) ◽  
pp. 187-192
Author(s):  
Mahmut Yesin ◽  
Metin Çağdaş ◽  
Macit Kalcik ◽  
İbrahim Rencüzoğulları ◽  
Yavuz Karabağ ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Hba1c Level ◽  
Depression Scale ◽  
Patients With Heart Failure ◽  
The Relationship

scholarly journals Plasma trimethylamine-N-oxide and related metabolites are associated with type 2 diabetes risk in the Prevención con Dieta Mediterránea (PREDIMED) trial

2018 ◽  
Vol 108 (1) ◽  
pp. 163-173 ◽  
Author(s):  
Christopher Papandreou ◽  
Mònica Bulló ◽  
Yan Zheng ◽  
Miguel Ruiz-Canela ◽  
Edward Yu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Multiple Testing ◽  
Cox Proportional Hazard ◽  
Cohort Design ◽  
Liquid Chromatography Tandem Mass ◽  
Cox Proportional Hazard Models ◽  
Dieta Mediterranea ◽  
Dieta Mediterránea

ABSTRACT Background The role of trimethylamine-N-oxide (TMAO) in type 2 diabetes (T2D) is currently partially understood and controversial. Objective The aim of this study was to investigate associations between TMAO and related metabolites with T2D risk in subjects at high risk of cardiovascular disease. Design This is a case-cohort design study within the Prevención con Dieta Mediterránea (PREDIMED) study, with 251 incident T2D cases and a random sample of 694 participants (641 noncases and 53 overlapping cases) without T2D at baseline (median follow-up: 3.8 y). We used liquid chromatography–tandem mass spectrometry to measure plasma TMAO, l-carnitine, betaine, lyso-phosphatidylcholine (LPC) and lyso-phosphatidylethanolamine (LPE) species, phosphocholine, α-glycerophosphocholine, and choline at baseline and after 1 y. We examined associations with the use of weighted Cox proportional hazard models, accounting for the weighted case-cohort design by the Barlow method. Results After adjustment for recognized T2D risk factors and multiple testing, individuals in the highest quartile of baseline TMAO and α-glycerophosphocholine had a lower risk of T2D [HR (95% CI): 0.52 (0.29, 0.89) and 0.46 (0.24, 0.89), respectively]. The HR (95% CI) comparing the extreme quartiles of betaine was 0.41 (0.23, 0.74). Similar trends were observed for C16:0 LPC, C18:1 LPC, C18:0 LPC, C20:4 LPC, C22:6 LPC, C18:1 LPC plasmalogen, and C16:0 LPE. After correcting for multiple comparisons, participants in the highest quartile of 1-y changes in oleic acid LPC plasmalogen concentrations had a lower T2D risk than the reference quartile. Conclusion Whether the associations between plasma TMAO and certain metabolite concentrations with T2D risk reflect its pathophysiology or represent an epiphenomenon needs to be elucidated. This trial is registered at http://www.controlled-trials.com as ISRCTN35739639.

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