HbA1c variability and all-cause mortality in type 1 and type 2 diabetes: A population-based cohort study using electronic health records
Authors' conclusion
Variability in HbA1c was associated with greater subsequent mortality among people living with diabetes, independent from average HbA1c. Future research should investigate whether reducing HbA1c variability over time in selected patients lowers mortality risk independent of HbA1c level improvements.
Study context
- Population
- People aged 31–90 with diabetes (T1D = 20,347; T2D = 409,821) with 4+ HbA1c measurements in the Clinical Practice Research Datalink 2011–14, alive on 1/1/2015
- Exposure
- Most vs least HbA1c variability
- Outcome
- All-cause mortality
- Follow-up
- 2015-17
Methodological detailselectronic health records, mutually adjusted for HbA1c level and variability
- Electronic health records
- Mutually adjusted for HbA1c level and variability
Main finding
As reported in the abstract
All-cause mortality, adjusted HR
HVS 80-100 vs HVS 0-20Adjusted hazard ratio (95 % CI)
T1D
2.78(2.15–3.60)
T2D
1.91(1.83–1.99)
Observational data: associations, not effects.
Further findings
Deaths during follow-up
- Died, T1D
- 1,043 (5.1 %)
- Died, T2D
- 40,723 (9.9 %)
Correlates of greater HbA1c variability
- Greater HbA1c variability associated with younger age, non-white ethnicities (T1D only), obesity, co-morbidities, and living in deprived areas
Original publication
HbA1c variability and all-cause mortality in type 1 and type 2 diabetes: A population-based cohort study using electronic health records. Diabetes Res Clin Pract. Published 6 May 2025. doi:10.
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