Display options
Cite
Skriver MV, Sandbæk A, Kristensen JK, et al. Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study. BMJ Open Diabetes Res Care. 2015;3(1):e000060doi: 10.1136/bmjdrc-2014-000060.
Skriver, M. V., Sandbæk, A., Kristensen, J. K., & Støvring, H. (2015). Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study. BMJ open diabetes research & care, 3(1), e000060. https://doi.org/10.1136/bmjdrc-2014-000060
Skriver, Mette V, et al. "Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study." BMJ open diabetes research & care vol. 3,1 (2015): e000060. doi: https://doi.org/10.1136/bmjdrc-2014-000060
Skriver MV, Sandbæk A, Kristensen JK, Støvring H. Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study. BMJ Open Diabetes Res Care. 2015 Jan 30;3(1):e000060. doi: 10.1136/bmjdrc-2014-000060. eCollection 2015. PMID: 25664182; PMCID: PMC4317527.
Copy Download .nbib Format: NLM
Share it on

BMJ Open Diabetes Res Care. 2015 Jan 30;3(1):e000060. doi: 10.1136/bmjdrc-2014-000060. eCollection 2015.

Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study.

BMJ open diabetes research & care

Mette V Skriver, Annelli Sandbæk, Jette K Kristensen, Henrik Støvring

Affiliations

  1. Department of Public Health , Health, Aarhus University , Aarhus C , Denmark.

PMID: 25664182 PMCID: PMC4317527 DOI: 10.1136/bmjdrc-2014-000060

Abstract

OBJECTIVE: We assessed the relationship of mortality with glycated hemoglobin (HbA1c) variability and with absolute change in HbA1c.

DESIGN: A population-based prospective observational study with a median follow-up time of 6 years.

METHODS: Based on a validated algorithm, 11 205 Danish individuals with type 2 diabetes during 2001-2006 were identified from public data files, with at least three HbA1c measurements: one index measure, one closing measure 22-26 months later, and one measurement in-between. Medium index HbA1c was 7.3%, median age was 63.9 years, and 48% were women. HbA1c variability was defined as the mean absolute residual around the line connecting index value with closing value. Cox proportional hazard models with restricted cubic splines were used, with all-cause mortality as the outcome.

RESULTS: Variability between 0 and 0.5 HbA1c percentage point was not associated with mortality, but for index HbA1c ≤8% (64 mmol/mol), a variability above 0.5 was associated with increased mortality (HR of 1 HbA1c percentage point variability was 1.3 (95% CI 1.1 to 1.5) for index HbA1c 6.6-7.4%). For index HbA1c≤8%, mortality increased when HbA1c declined, but was stable when HbA1c rose. For index HbA1c>8%, change in HbA1c was associated with mortality, with the lowest mortality for greatest decline (HR=0.9 (95% CI 0.80 to 0.98) for a 2-percentage point decrease).

CONCLUSIONS: For individuals with an index HbA1c below 8%, both high HbA1c variability and a decline in HbA1c were associated with increased mortality. For individuals with index HbA1c above 8%, change in HbA1c was associated with mortality, whereas variability was not.

Keywords: Change; HbA1c; Mortality; Type 2 Diabetes

References

  1. Diabetes Care. 2008 Nov;31(11):2198-202 - PubMed
  2. Diabetologia. 2012 Dec;55(12):3163-72 - PubMed
  3. J Intern Med. 2001 Mar;249(3):225-35 - PubMed
  4. Diabet Med. 2012 Dec;29(12):1562-6 - PubMed
  5. Dan Med Bull. 1999 Jun;46(3):263-8 - PubMed
  6. Lancet. 2011 Jul 2;378(9785):31-40 - PubMed
  7. Diabetes Care. 2013 Aug;36(8):2301-10 - PubMed
  8. N Engl J Med. 1999 Jan 7;340(1):14-22 - PubMed
  9. Diabetologia. 2012 Aug;55(8):2128-31 - PubMed
  10. Ugeskr Laeger. 2007 Apr 30;169(18):1687-92 - PubMed
  11. JAMA. 2003 Jan 1;289(1):76-9 - PubMed
  12. J Chronic Dis. 1987;40(5):373-83 - PubMed
  13. N Engl J Med. 2011 Mar 3;364(9):829-41 - PubMed
  14. N Engl J Med. 2008 Jun 12;358(24):2545-59 - PubMed
  15. Diabetologia. 2012 Sep;55(9):2361-70 - PubMed
  16. Diabetes Care. 2010 May;33(5):983-90 - PubMed
  17. Cardiovasc Diabetol. 2013 Jul 05;12:98 - PubMed
  18. Diabetes Care. 2004 May;27(5):1047-53 - PubMed
  19. Diabetologia. 2008 Jan;51(1):8-11 - PubMed
  20. J Diabetes Complications. 2012 Jul-Aug;26(4):296-300 - PubMed
  21. Diabetologia. 2009 Nov;52(11):2288-98 - PubMed
  22. Diabetes. 2009 Nov;58(11):2649-55 - PubMed
  23. Epidemiology. 1995 Jul;6(4):356-65 - PubMed
  24. Diabetes Care. 2014 Aug;37(8):2359-65 - PubMed
  25. Korean Diabetes J. 2010 Jun;34(3):174-81 - PubMed
  26. Diabetologia. 2012 Mar;55(3):636-43 - PubMed
  27. Lancet. 2010 Feb 6;375(9713):481-9 - PubMed
  28. Lancet. 2009 May 23;373(9677):1765-72 - PubMed
  29. Dan Med Bull. 2001 Feb;48(1):33-7 - PubMed
  30. Diabetes Res Clin Pract. 2011 Dec;94(3):311-21 - PubMed
  31. Dan Med Bull. 2006 Nov;53(4):441-9 - PubMed
  32. Scand J Public Health. 2011 Jul;39(7 Suppl):30-3 - PubMed
  33. J Diabetes Investig. 2012 Mar 28;3(2):148-55 - PubMed
  34. Diabetes Care. 2011 Apr;34(4):1011-3 - PubMed

Publication Types