Glycemic control, HbA1c variability, and major cardiovascular adverse outcomes in type 2 diabetes patients with elevated cardiovascular risk: insights from the ACCORD study
Authors' conclusion
HbA1c variability can guide glycemic control targets for patients with type 2 diabetes. For patients with low variability, the lower the HbA1c, the lower the risk. For those with medium variability, controlling HbA1c at 7.5% provides the maximum benefit. For patients with high variability, a mean HbA1c of around 7.8% presents the lowest risk of all-cause mortality, a lower HbA1c did not provide cardiovascular benefits but instead increased the mortality risk. Further studies, especially those with patients that reflect the general population with type 2 diabetes undergoing the latest therapeutic approaches, are essential to validate the conclusions of this study.
Study context
- Population
- T2D patients with elevated cardiovascular risk, ACCORD study data
- Comparison
- Intensive vs standard glucose-lowering treatment, by HbA1c variability cluster; mean HbA1c
Methodological detailsK-means and K-medians clustering of HbA1c variability (HbA1c variability score (HVS) and SD)
- K-means and K-medians clustering of HbA1c variability (HVS and SD)
Primary result
As reported in the abstract
- Low variability: intensive treatment, adverse cardiovascular outcomes, HR
- 0.78 (0.63, 0.97) (95% CI)
- Low variability: intensive treatment, mortality, HR
- 1.07 (0.81, 1.42)
- Low variability: increasing mean HbA1c, adverse cardiovascular events, HR
- 1.33 (1.14, 1.56)
- Low variability: increasing mean HbA1c, all-cause mortality, HR
- 1.23 (1.01,1.51)
- High variability: intensive treatment, cardiovascular events, HR
- 2.00 (1.54, 2.60)
- High variability: intensive treatment, mortality, HR
- 2.20 (1.66, 2.92)
- High variability: mean HbA1c with lowest mortality risk
- 7.86% (7.66%, 8.06%)
- High variability: below mean HbA1c 7.86%, higher mean HbA1c and mortality, HR
- 0.63 (0.42, 0.95)
- Medium variability: mean HbA1c associated with lowest risk
- around 7.5%
Original publication
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