期刊
CHINESE MEDICAL JOURNAL
卷 135, 期 19, 页码 2294-2300出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CM9.0000000000002073
关键词
Visit-to-visit HbAlc variability; Type 2 diabetes; Macrovascular complications; All-cause mortality; Glycated hemoglobin
资金
- National Key R&D Program of China [20l8YFC2SSlSSX]
- 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University [ZYGD18022, 20HXFH011]
This systematic review summarizes the evidence of HbAlc variability in patients with type 2 diabetes. The findings suggest that high HbAlc variability is associated with increased risks of all-cause mortality, cardiovascular events, progression to chronic kidney disease, amputation, and peripheral neuropathy. Therefore, patients with type 2 diabetes and high HbAlc variability require additional attention and care for potential adverse outcomes.
Background:Current practice uses the latest measure of glycated hemoglobin (HbAlc) to facilitate clinical decision-making. Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes. However, the role of HbAlc variability is unclear in clinical practice. This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro- and macro-vascular complications and death in people with type 2 diabetes.Methods:We searched PubMed, EMBASE (via OVID), and Cochrane Central Register (CENTRAL, via OVID) for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation (SD), coefficient of variation (CV), and HbAlc variability score (HVS).Results:In people with type 2 diabetes, the highest quantile of all three HbAlc variability metrics (HbAlc-standard deviation [HbAlc-SD], HbAlc-coefficient of variance [HbAlc-CV], and HVS) is associated with increased risks of all-cause mortality, cardiovascular events, progression to chronic kidney disease, amputation, and peripheral neuropathy. For example, the hazard ratio of HbAlc-SD on all-cause mortality was l.89 with 95% confidence interval (95% CI) l.46-2.45 (HbAlc-CV l.47, 95% CI l.26-l.72; HVS l.67, 95% CI l.34-2.09).Conclusions:High HbAlc variability leads to micro- and macro-vascular complications of type 2 diabetes and related death. People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.
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