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Horm Metab Res 2022; 54(02): 94-103
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

Kai Guo‡
1   Department of Intensive Care Unit, The First People’s Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
,
Qian Zhao‡
2   Department of Endocrinology, Huai’an Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Huaian, Jiangsu, China
,
Meng Wang‡
3   The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu, China
,
Yuchun Lu‡
3   The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu, China
,
Meihong Wo‡
3   The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu, China
,
Xiaoyan Zhou
4   School of Basic Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
,
Changjiang Ying 
5   Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
› Author Affiliations 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).
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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.

Key words

HbA1c variability - type 2 diabetes - vascular complications - meta-analysis

Supplementary Material



Publication History

Received: 12 October 2021

Accepted after revision: 15 December 2021

Article published online:
07 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
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