Changes in HbA1c during the first six years after the diagnosis of Type 2 diabetes mellitus predict long-term microvascular outcomes
Autoři:
Maarten P. Rozing aff001; Anne Møller aff001; Rune Aabenhus aff001; Volkert Siersma aff001; Katja Rasmussen aff001; Rasmus Køster-Rasmussen aff001
Působiště autorů:
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
aff001
Vyšlo v časopise:
PLoS ONE 14(11)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0225230
Souhrn
To analyze the association between change in HbA1c during the first 6 years after diagnosis of Type 2 diabetes mellitus (Type 2 DM) and incident micro- and macrovascular morbidity and mortality during 13 years thereafter. This is an observational study of the participants in the intervention arm of the randomized controlled trial Diabetes Care in General Practice (DCGP) in Denmark. 494 newly diagnosed persons with Type 2 DM aged 40 years and over with three or more measurements of HbA1c during six years of intervention were included in the analyses. Based on a regression line, fitted through the HbA1c-measurements from 1 to 6 years after diabetes diagnosis, glycaemic control was characterized by the one-year level of HbA1c after diagnosis, and the slope of the regression line. Outcomes were incident diabetes-related morbidity and mortality from 6 to 19 years after diabetes diagnosis. The association between change in HbA1c (the slope of the regression line) and clinical outcomes were assessed in adjusted Cox regression models. The median HbA1c level at year one was 60 (IQR: 52–71) mmol/mol or (7.65 (IQR: 6.91–8.62) %). Higher HbA1c levels one year after diagnosis were associated with a higher risk of later diabetes-related morbidity and mortality. An increase in HbA1c during the first 6 years after diabetes diagnosis was associated with later microvascular complications (HR per 1.1 mmol/mol or 0.1% point increase in HbA1c per year; 95% CI) = 1.14; 1.05–1.24). Change in HbA1c did not predict the aggregate outcome ‘any diabetes-related endpoint, all-cause mortality, diabetes-related mortality, myocardial infarction, stroke, or peripheral vascular diseases. We conclude that suboptimal development of glycaemic control during the first 6 years after diabetes diagnosis was an independent risk factor for microvascular complications during the succeeding 13-year follow-up, but not for mortality or macrovascular complications.
Klíčová slova:
Diabetes diagnosis and management – Insulin – Myocardial infarction – Morbidity – Peripheral vascular disease
Zdroje
1. Goff DC Jr., Gerstein HC, Ginsberg HN, Cushman WC, Margolis KL, Byington RP, et al. Prevention of cardiovascular disease in persons with type 2 diabetes mellitus: current knowledge and rationale for the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. AmJCardiol. 2007;99(12A):4i–20i. doi: 10.1016/j.amjcard.2007.03.002 17599424
2. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di AE, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22. doi: 10.1016/S0140-6736(10)60484-9 20609967
3. Gerstein HC, Pogue J, Mann JF, Lonn E, Dagenais GR, McQueen M, et al. The relationship between dysglycaemia and cardiovascular and renal risk in diabetic and non-diabetic participants in the HOPE study: a prospective epidemiological analysis. Diabetologia. 2005;48(9):1749–55. doi: 10.1007/s00125-005-1858-4 16059716
4. Gerstein HC, Islam S, Anand S, Almahmeed W, Damasceno A, Dans A, et al. Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study. Diabetologia. 2010;53(12):2509–17. doi: 10.1007/s00125-010-1871-0 20711717
5. Cavero-Redondo I, Peleteiro B, Alvarez-Bueno C, Rodriguez-Artalejo F, Martinez-Vizcaino V. Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysis. BMJ Open. 2017;7(7):e015949. doi: 10.1136/bmjopen-2017-015949 28760792
6. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53. 9742976.
7. Skrha J, Soupal J, Skrha J Jr., Prazny M. Glucose variability, HbA1c and microvascular complications. RevEndocrMetab Disord. 2016;17(1):103–10. doi: 10.1007/s11154-016-9347-2 26975588
8. Olivarius NF, Beck-Nielsen H, Andreasen AH, Horder M, Pedersen PA. Randomised controlled trial of structured personal care of type 2 diabetes mellitus. BMJ. 2001;323(7319):970–5. doi: 10.1136/bmj.323.7319.970 11679387
9. Hansen LJ, Siersma V, Beck-Nielsen H, de Fine ON. Structured personal care of type 2 diabetes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP). Diabetologia. 2013;56(6):1243–53. doi: 10.1007/s00125-013-2893-1 23549519
10. Olivarius NF, Siersma V, Hansen LJ, Drivsholm T, Horder M. Changes in levels of haemoglobin A1c during the first 6 years after diagnosis of clinical type 2 diabetes. ScandJClinLab Invest. 2009;69(8):851–7. doi: 10.3109/00365510903323191 19929282
11. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405–12. doi: 10.1136/bmj.321.7258.405 10938048
12. Krag MO, Hasselbalch L, Siersma V, Nielsen AB, Reventlow S, Malterud K, et al. The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study. Diabetologia. 2016;59(2):275–85. doi: 10.1007/s00125-015-3804-4 26607637.
13. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;Suppl 1:S62–S9.
14. Pedersen CB, Gotzsche H, Moller JO, Mortensen PB. The Danish Civil Registration System. A cohort of eight million persons. DanMedBull. 2006;53(4):441–9.
15. Veloso AG, Siersma V, Heldgaard PE, de Fine ON. Patients newly diagnosed with clinical type 2 diabetes mellitus but presenting with HbA1c within normal range: 19-year mortality and clinical outcomes. PrimCare Diabetes. 2013;7(1):33–8. doi: 10.1016/j.pcd.2012.09.001 23041240
16. Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review. Int JBehavNutrPhysAct. 2011;8:115. doi: 10.1186/1479-5868-8-115 22018588
17. Svensson E, Baggesen LM, Johnsen SP, Pedersen L, Norrelund H, Buhl ES, et al. Early Glycemic Control and Magnitude of HbA1c Reduction Predict Cardiovascular Events and Mortality: Population-Based Cohort Study of 24,752 Metformin Initiators. Diabetes Care. 2017;40(6):800–7. doi: 10.2337/dc16-2271 28404659
18. Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal TP, Hemmingsen C, et al. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. CochraneDatabaseSystRev. 2013;(11):CD008143. doi: 10.1002/14651858.CD008143.pub3 24214280
19. Hayward RA, Reaven PD, Wiitala WL, Bahn GD, Reda DJ, Ge L, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. NEnglJMed. 2015;372(23):2197–206. doi: 10.1056/NEJMoa1414266 26039600
20. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. NEnglJMed. 2008;358(24):2560–72. doi: 10.1056/NEJMoa0802987 18539916
21. Gerstein HC, Miller ME, Byington RP, Goff DC Jr., Bigger JT, Buse JB, et al. Effects of intensive glucose lowering in type 2 diabetes. NEnglJMed. 2008;358(24):2545–59. doi: 10.1056/NEJMoa0802743 18539917
22. Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. NEnglJMed. 2008;358(6):580–91. doi: 10.1056/NEJMoa0706245 18256393
23. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. NEnglJMed. 2005;353(25):2643–53. doi: 10.1056/NEJMoa052187 16371630
Článok vyšiel v časopise
PLOS One
2019 Číslo 11
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Je Fuchsova endotelová dystrofie rohovky neurodegenerativní onemocnění?
- Fixní kombinace paracetamol/kodein nabízí synergické analgetické účinky
Najčítanejšie v tomto čísle
- A daily diary study on maladaptive daydreaming, mind wandering, and sleep disturbances: Examining within-person and between-persons relations
- A 3’ UTR SNP rs885863, a cis-eQTL for the circadian gene VIPR2 and lincRNA 689, is associated with opioid addiction
- A substitution mutation in a conserved domain of mammalian acetate-dependent acetyl CoA synthetase 2 results in destabilized protein and impaired HIF-2 signaling
- Molecular validation of clinical Pantoea isolates identified by MALDI-TOF