HbA1c Reduction and Risk of Cardiovascular Diseases in Type 2 Diabetes: An Observational Study from the Swedish NDR
6/11/2012 12:00:00 PM
6/11/2012 2:00:00 PM
, BJÖRN ELIASSON, BJÖRN ZETHELIUS, ANN-MARIE SVENSSON, SOFFIA GUDBJÖRNSDOTTIR, JAN CEDERHOLM,
The relationship between glycemic control and cardiovascular risk in type 2 diabetes (T2D) remains unclear. The aim of this observational study was to assess the association between improved glycemic control during follow-up and risk for coronary heart disease (CHD), cardiovascular disease (CVD) and total mortality in patients with T2D from the Swedish National Diabetes Register, baseline HbA1c 7-8.9%, aged 30-75 years, with no previous CVD, followed-up from 2004 to 2009 (mean 5.7 years).
Two groups of patients were created based on the median for change in HbA1c during follow-up: 8923 patients (mean baseline age 62.0 years, diabetes duration 8.3 years) with HbA1c decreasing 0.1% or more from baseline to follow-up (mean baseline HbA1c 7.8±0.5% and final 7.0±0.6%), and 9112 patients (mean baseline age 61.3 years, duration 9.2 years) with stable or increasing HbA1c 0.1% or more (mean baseline HbA1c 7.7±0.5% and final 8.3±0.9%).
Absolute risk of first-incident fatal/nonfatal CVD was 15.1 events per 1000 person-years in patients with decreasing HbA1c and 26.1 in patients with stable/increasing HbA1c. Adjusted hazard ratios at Cox regression analysis for first-incident fatal/nonfatal CHD, fatal/nonfatal CVD and total mortality, with decreasing HbA1c compared to stable/increasing HbA1c, were 0.61 (95% CI 0.54-0.69), 0.63 (0.57-0.70), and 0.55 (0.49-0.63), respectively, all p<0.001. Adjustment was made for a propensity score with stratification by quintiles, including covariates age, sex, diabetes duration, baseline HbA1c and traditional CVD risk factors and treatments, as well as changes in these risk factors and treatments during the study period. Differences in included covariates between the two groups were balanced when adjusted with the propensity score.
HbA1c reduction of mean 0.8% from mean 7.8% to 7.0% (to the treatment target) was associated with substantially lower risk of CHD, CVD and total mortality, compared to stable/increasing HbA1c of 7.7 to 8.3.
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