Routine HbA1c monitoring and cardiovascular outcomes in diabetes: Evidence from a large Spanish cohort

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes Pub Date : 2026-02-01 Epub Date: 2025-12-16 DOI:10.1016/j.pcd.2025.11.012

Domingo Orozco-Beltran , Samuel Seidu , Jose Antonio Quesada

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引用次数: 0

Abstract

AIM

Glycated hemoglobin (HbA_1c) is a key indicator of diabetes control. However, the risk of missing HbA_1c values in clinical records is unknown. We aimed to analyze the relationship between missing HbA_1c values and the occurrence of major cardiovascular events or death from all causes.

Methods

Retrospective cohort study based on a national database of primary care electronic medical records in Spain (BIFAP). We included people aged 30 years and older with an incident diagnosis of diabetes mellitus. Follow-up started on the date of diabetes diagnosis between 2005 and 2019, and ended on occurrence of composite endpoint (major cardiovascular events and/or death from all causes), or December 31st, 2019. The baseline exposure variable was HbA_1c (< 7 %, 7 %–8 %, > 8 %, missing). Cox models were fitted.

Results

Our analysis included 303,199 people with diabetes, with an average age of 62.2 years and 44.7 % were women. The mean follow-up was 5.7 years, and 10.2 % of patients had missing HbA_1c values. The cardiovascular risk was 1.18 (95 %CI: 1.14–1.22) in the HbA_1c 7 %-8 % group, 1.41 (95 %CI: 1.36–1.46) in HbA_1c > 8 %, and 2.95 (95 %CI: 2.89–3.05) in HbA_1c missing, compared with HbA_1c < 7 %.

Conclusions

In this large cohort of people with newly diagnosed diabetes, missing HbA1c values was associated with a significantly higher risk of major cardiovascular events or death, more than double the risk observed in people with the worst glycemic control. These findings underscore the clinical importance of routinely recording and monitoring HbA1c at diagnosis, not only as a marker of metabolic control but also as a potential prognostic indicator. The lack of HbA1c may act as an indicator of suboptimal clinical follow-up.

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糖尿病患者常规HbA1c监测与心血管结局：来自西班牙大型队列的证据

目的：糖化血红蛋白（HbA1c）是糖尿病控制的关键指标。然而，临床记录中遗漏HbA1c值的风险尚不清楚。我们的目的是分析HbA1c缺失与主要心血管事件发生或全因死亡之间的关系。方法：基于西班牙国家初级保健电子病历数据库（BIFAP）的回顾性队列研究。我们纳入了年龄在30岁及以上且有糖尿病偶发诊断的患者。随访开始于2005年至2019年糖尿病诊断之日，结束于复合终点（主要心血管事件和/或全因死亡）的发生，或2019年12月31日。基线暴露变量为HbA1c（< 7 %,7 %-8 %,> 8 %，缺失）。拟合Cox模型。结果：我们的分析包括303,199例糖尿病患者，平均年龄为62.2岁，44.7% %为女性。平均随访5.7年，10. %的患者HbA1c值缺失。与HbA1c相比，HbA1c 7 %-8 %组的心血管风险为1.18(95 %CI: 1.14-1.22)， HbA1c 1 %-8 %组的风险为1.41(95 %CI: 1.36-1.46)， HbA1c缺失组的风险为2.95（95 %CI: 2.89-3.05）。结论：在这个新诊断的糖尿病患者的大型队列中，HbA1c缺失与主要心血管事件或死亡的风险显著升高相关，比血糖控制最差的人群的风险高出一倍以上。这些发现强调了常规记录和监测HbA1c在诊断中的临床重要性，不仅作为代谢控制的标志，而且作为潜在的预后指标。缺乏HbA1c可能是临床随访不理想的一个指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Primary Care Diabetes ENDOCRINOLOGY & METABOLISM-PRIMARY HEALTH CARE

CiteScore

5.00

自引率

3.40%

发文量

134

审稿时长

47 days

期刊介绍： The journal publishes original research articles and high quality reviews in the fields of clinical care, diabetes education, nutrition, health services, psychosocial research and epidemiology and other areas as far as is relevant for diabetology in a primary-care setting. The purpose of the journal is to encourage interdisciplinary research and discussion between all those who are involved in primary diabetes care on an international level. The Journal also publishes news and articles concerning the policies and activities of Primary Care Diabetes Europe and reflects the society''s aim of improving the care for people with diabetes mellitus within the primary-care setting.