The legacy effect of early HbA1c control on microvascular complications and hospital admissions in type 2 diabetes: findings from a large UK study.

IF 3.9 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Therapeutic Advances in Endocrinology and Metabolism Pub Date : 2025-06-20 eCollection Date: 2025-01-01 DOI:10.1177/20420188251350897
Rami Aldafas, Yana Vinogradova, Thomas S J Crabtree, Jason Gordon, Iskandar Idris
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引用次数: 0

Abstract

Introduction: There is conflicting evidence regarding optimal glycaemic targets to reflect the legacy effect of hyperglycaemia in people with type 2 diabetes (T2D). We examined the risks of microvascular complications and hospital admission with glycated haemoglobin (HbA1c) levels from the diagnosis of T2D.

Methods: We identified individuals with incident T2D from 1998 to 2007 from the Clinical Practice Research Datalink and Hospital Episode Statistics. A composite microvascular outcome was defined as a new diagnosis of neuropathy, nephropathy or retinopathy. A multivariate time-varying Cox regression analysis was performed to assess the risk of microvascular disease associated with HbA1c at five different levels (1.0% (11 mmol/mol) intervals). HbA1c 6.5%-7.5% (48.0-58.9 mmol/mol) was defined as the reference.

Results: N = 172,869 (mean age 62.6 ± 14.0 years, 54.6% female) were analysed. Average follow-up was 11.2 years. The risk of microvascular disease increased with higher HbA1c levels, the highest risk in the ⩾9.6% (⩾81 mmol/mol; hazard ratio (HR): 1.29, 95% confidence interval (CI): 1.11-1.51) and the lowest in the <6.5% (<48.0 mmol/mol; HR: 0.94, 95% CI: 0.83-1.08). The risk of hospital admission suggested a U-shaped association with HbA1c, highest risk in the lowest (<6.5% (<48.0 mmol/mol); HR: 1.04, 95% CI: 1.01-1.07) followed by HbA1c groups (8.6%-9.6% (70.0-81.0 mmol/mol); HR: 1.02, 95% CI: 0.97-1.08) while the lowest risk for hospital admission was observed for targets with the reference group (target between 6.5% and 7.5%, (48.0-58.9 mmol/mol)).

Conclusion: The risk of microvascular complications was lowest when HbA1c levels were within the non-diabetic range and increased with higher HbA1c levels. The risk of hospital admission was significantly elevated in individuals with HbA1c levels below 6.5%, suggesting a potential U-shaped association, although the increased risk at higher HbA1c levels did not reach statistical significance. This highlights the importance of maintaining individualised HbA1c targets in the management of T2D from diagnosis to prevent these complications.

早期HbA1c控制对2型糖尿病微血管并发症和住院率的影响:来自英国一项大型研究的结果
关于2型糖尿病(T2D)患者高血糖遗留效应的最佳血糖目标,存在相互矛盾的证据。我们检查了微血管并发症的风险和t2dm诊断时糖化血红蛋白(HbA1c)水平的住院率。方法:我们从临床实践研究数据链和医院事件统计中确定1998年至2007年发生T2D事件的个体。复合微血管预后被定义为神经病变、肾病或视网膜病变的新诊断。采用多变量时变Cox回归分析,评估5种不同HbA1c水平(1.0% (11 mmol/mol)区间)下微血管疾病的风险。以HbA1c 6.5% ~ 7.5% (48.0 ~ 58.9 mmol/mol)为基准。结果:分析N = 172,869例(平均年龄62.6±14.0岁,女性54.6%)。平均随访时间为11.2年。微血管疾病的风险随着HbA1c水平的升高而增加,在小于或等于9.6%(大于或等于81 mmol/mol;结论:HbA1c水平在非糖尿病范围内时微血管并发症发生风险最低,且随HbA1c水平升高而升高。在HbA1c水平低于6.5%的个体中,入院风险显著升高,提示存在潜在的u型关联,尽管HbA1c水平较高时风险增加没有达到统计学意义。这突出了从诊断到预防这些并发症,在T2D管理中维持个体化HbA1c目标的重要性。
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来源期刊
Therapeutic Advances in Endocrinology and Metabolism
Therapeutic Advances in Endocrinology and Metabolism Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
7.70
自引率
2.60%
发文量
42
审稿时长
8 weeks
期刊介绍: Therapeutic Advances in Endocrinology and Metabolism delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of endocrinology and metabolism.
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