Identifying the independent effect of HbA variability on adverse health outcomes in patients with Type 2 diabetes.

Prentice JC, Pizer SD, Conlin PR. Identifying the independent effect of HbA variability on adverse health outcomes in patients with Type 2 diabetes. Diabetic medicine : a journal of the British Diabetic Association. 2016 Dec 1; 33(12):1640-1648.

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Abstract:

AIMS: To characterize the relationship between HbA variability and adverse health outcomes among US military veterans with Type 2 diabetes. METHODS: This retrospective cohort study used Veterans Affairs and Medicare claims for veterans with Type 2 diabetes taking metformin who initiated a second diabetes medication (n = 50 861). The main exposure of interest was HbA variability during a 3-year baseline period. HbA variability, categorized into quartiles, was defined as standard deviation, coefficient of variation and adjusted standard deviation, which accounted for the number and mean number of days between HbA tests. Cox proportional hazard models predicted mortality, hospitalization for ambulatory care-sensitive conditions, and myocardial infarction or stroke and were controlled for mean HbA levels and the direction of change in HbA levels during the baseline period. RESULTS: Over a mean 3.3 years of follow-up, all HbA variability measures significantly predicted each outcome. Using the adjusted standard deviation measure for HbA variability, the hazard ratios for the third and fourth quartile predicting mortality were 1.14 (95% CI 1.04, 1.25) and 1.42 (95% CI 1.28, 1.58), for myocardial infarction and stroke they were 1.25 (95% CI 1.10, 1.41) and 1.23 (95% CI 1.07, 1.42) and for ambulatory-care sensitive condition hospitalization they were 1.10 (95% CI 1.03, 1.18) and 1.11 (95% CI 1.03, 1.20). Higher baseline HbA levels independently predicted the likelihood of each outcome. CONCLUSIONS: In veterans with Type 2 diabetes, greater HbA variability was associated with an increased risk of adverse long-term outcomes, independently of HbA levels and direction of change. Limiting HbA fluctuations over time may reduce complications.