Visit to Visit Hemoglobin A1c Variation and Long-term Risk of Major Adverse Limb Events in Patients With Type 2 Diabetes

Author:

Hsiao Fu-Chih1ORCID,Chan Yi-Hsin1234,Tung Ying-Chang1,Lin Chia-Pin1,Lee Ting-Hein156,Wang Yu-Chiang78,Chu Pao-Hsien129ORCID

Affiliation:

1. Cardiovascular Department, Chang Gung Memorial Hospital , Linkou, Taoyuan 333 , Taiwan

2. College of Medicine, Chang Gung University , Taoyuan 333 , Taiwan

3. School of Traditional Chinese Medicine, College of Medicine, Chang Gung University , Taoyuan 333 , Taiwan

4. Microscopy Core Laboratory, Chang Gung Memorial Hospital , Linkou, Taoyuan 333 , Taiwan

5. Department of Anatomy, College of Medicine, Chang Gung University , Taoyuan 333 , Taiwan

6. Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University , Taoyuan 333 , Taiwan

7. Department of Medicine, Brigham and Women's Hospital , Boston, MA 02115 , USA

8. School of Medicine, Harvard University , Boston, MA 02115 , USA

9. Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital , Linkou, Taoyuan 333 , Taiwan

Abstract

Abstract Context Glycemic variation had been demonstrated to be associated with several complications of diabetes. Objective Investigation of the association between visit to visit hemoglobin A1c (HbA1c) variation and the long-term risk of major adverse limb events (MALEs). Methods Retrospective database study. Average real variability was used to represent glycemic variations with all the HbA1c measurements during the 4 following years after the initial diagnosis of type 2 diabetes. Participants were followed from the beginning of the fifth year until death or the end of the follow-up. The association between HbA1c variations and MALEs was evaluated after adjusting for mean HbA1c and baseline characteristics. Included were 56 872 patients at the referral center with a first diagnosis of type 2 diabetes, no lower extremity arterial disease, and at least 1 HbA1c measurement in each of the 4 following years were identified from a multicenter database. The main outcome measure was incidence of a MALE, which was defined as the composite of revascularization, foot ulcers, and lower limb amputations. Results The average number of HbA1c measurements was 12.6. The mean follow-up time was 6.1 years. The cumulative incidence of MALEs was 9.25 per 1000 person-years. Visit to visit HbA1c variations were significantly associated with MALEs and lower limb amputation after multivariate adjustment. People in the highest quartile of variations had increased risks for MALEs (HR 1.25, 95% CI 1.10-1.41) and lower limb amputation (HR 3.05, 95% CI 1.97-4.74). Conclusion HbA1c variation was independently associated with a long-term risk of MALEs and lower limb amputations in patients with type 2 diabetes.

Funder

Ministry of Science and Technology

Chang Gung Memorial Hospital

Publisher

The Endocrine Society

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism

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