Visit‐to‐visit HbA1c variability and risk of potentially avoidable hospitalisations in adults with type 2 diabetes receiving outpatient care at a tertiary hospital
Authors' conclusion
In individuals receiving care at specialist outpatient clinics of a tertiary hospital, HbA1c variability is associated with a higher risk of PAH. Comprehensive diabetes management strategies addressing both glycaemic control and variability may offer benefits.
Study context
- Population
- Adults aged 21 to 101 years with T2D and ≥3 HbA1c tests over 2 years, tertiary hospital outpatient care, Singapore; mean age 62.9 ± 12.9 years, 55% male
- Participants
- 14,923 adults
- Exposure
- Quartiles of visit-to-visit HbA1c variability, Q2–Q4 vs Q1
- Outcome
- Potentially avoidable hospitalisations (PAH; overall, acute, chronic and diabetes composites) and all-cause hospitalisations
- Follow-up
- 1-year after the last HbA1c measurement
Methodological detailssingle-centre, tertiary hospital
- Single-centre
- Tertiary hospital
Main finding
As reported in the abstract
Diabetes-related PAH by HbA1c CV quartile · 1 year
Each group vs Q1Risk ratio (95% CI)
Q2
1.32(0.93–1.88)
Q3
1.65(1.18–2.31)
Q4
2.16(1.54–3.03)
Observational data: associations, not effects.
Further findings
| Outcome | Risk ratio (95% CI) | |
|---|---|---|
| All-cause hospitalisations by HbA1c CV quartile · 1 yearQ2vs Q1 | 0.97 (0.90–1.05) | |
| All-cause hospitalisations by HbA1c CV quartile · 1 yearQ3vs Q1 | 1.08 (1.00–1.17) | |
| All-cause hospitalisations by HbA1c CV quartile · 1 yearQ4vs Q1 | 1.16 (1.07–1.26) | |
| 0.512Risk ratio (log scale) |
HbA1c variability
- Median HbA1c coefficient of variation (CV) (IQR 5.1-14.3)
- 8.6%
Potentially avoidable hospitalisations (PAH) stratified by glycaemic control
- Elevated risk of PAH persisted even in those with optimal glycaemic control
Other variability measures (variability independent of the mean (VIM), HbA1c variability score (HVS))
- Consistent findings using HbA1c VIM and HVS
Original publication
Visit‐to‐visit HbA1c variability and risk of potentially avoidable hospitalisations in adults with type 2 diabetes receiving outpatient care at a tertiary hospital. Diabetes Obes Metab. Published 28 October 2024. doi:10.
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