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Horm Metab Res 2022; 54(02): 94-103
DOI: 10.1055/a-1730-4904
DOI: 10.1055/a-1730-4904
Endocrine Care
The Scope of HbA1c Variability and Risk of Vascular Complications Among Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Prospective Studies
Funding information The study was supported by the Certificate of China Postdoctoral Science Foundation Grant (No. 2019M651970), the Natural Science Foundation of the Jiangsu Higher Education Institution of China (No. 17KJD310005), the Jiangsu Province Graduate Student Innovation Project (No. KYCX19-2214), and the Xuzhou Medical University Research Project (No. 2017KJ03).
Abstract
Glycated hemoglobin (HbA1c) variability is emerging as an indicator of long-term glycemic control, which may play a significant role during vascular complications. We conducted a systematic review and meta-analysis to assess the association between the scope of HbA1c variability and vascular complications in patients with type 2 diabetes mellitus. PubMed and Embase were searched for studies that evaluated the association of HbA1c variability with vascular complications in patients with type 2 diabetes. Two reviewers independently completed data extraction. Random-effects meta-analysis was conducted with stratification according to the type of vascular complications. Nine studies were eligible for inclusion in our systematic review and meta-analysis. Six studies evaluated the impact of the standard deviation of HbA1c (HbA1c-SD) on cardiovascular events and showed an association of HbA1c-SD with cardiovascular events (HR: 1.25, 95% CI 1.18–1.32, 5 studies). Six studies evaluated renal disease associated with HbA1c-SD and showed that HbA1c-SD was correlated with an increased risk of renal disease (HR: 1.19, 95% CI 1.13–1.24). Two studies evaluated HbA1c-SD and the risk of retinopathy and showed that no significant association was found between retinopathy and HbA1c-SD (HR 1.08, 95% CI 0.92–125). For HbA1c-SD ranging from 0.6 to 0.8%, HbA1c-SD was associated with an increased risk of cardiovascular events (HR: 1.25, 95% CI 1.15–1.35) and renal disease (HR: 1.16, 95% CI 1.11–1.22). For individuals with index HbA1c variability greater than or equal to 0.6%, HbA1c variability was significantly associated with vascular complications in patients with type 2 diabetes mellitus.
Publication History
Received: 12 October 2021
Accepted after revision: 15 December 2021
Article published online:
07 February 2022
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