Prognostic impact of HbA1c variability on long-term outcomes in patients with heart failure and type 2 diabetes mellitus

• Published in: Cardiovascular diabetology 2018-06, Vol.17 (1), p.96-96, Article 96
• Main Authors: Gu, Jun, Pan, Jian-An, Fan, Yu-Qi, Zhang, Hui-Li, Zhang, Jun-Feng, Wang, Chang-Qian
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Aged; Biomarkers - blood; Cardiology; Cardiomyopathy; Cardiovascular disease; Comorbidity; Death; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - mortality; Diabetes Mellitus, Type 2 - therapy; Female; Glucose; Glycated Hemoglobin A - metabolism; Heart diseases; Heart failure; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Hemoglobin; Hemoglobin A1c variability; Hospitalization; Humans; Hyperglycemia; Longitudinal Studies; Male; Middle Aged; Mortality; Original Investigation; Patient Readmission; Patients; Phenotypes; Prognosis; Prospective Studies; Risk Factors; Short term; Statistical analysis; Statistical models; Stroke Volume; Time Factors; Type 2 diabetes mellitus; Variability; Variables; Ventricular Function, Left
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-018-0739-3

The prognostic impact of long-term glycemic variability on clinical outcomes in patients with heart failure (HF) and type 2 diabetes mellitus (T2DM) remains unclear. We determined and compared hemoglobin A1c (HbA1c) variability and clinical outcomes for patients with HF with preserved ejection fraction (HFpEF), HF with mid-range ejection fraction (HFmrEF) and HF with reduced ejection fraction (HFrEF) in a prospective longitudinal study. Patients with HF and T2DM, undergone 3 or more HbA1c determinations during the first 18 months, were then followed for 42 months. The primary outcome was death from any cause. Secondary outcome was composite endpoints with death and HF hospitalization. Cox proportional hazards models were used to compare outcomes for patients with HFpEF, HFmrEF and HFrEF. Of 902 patients enrolled, 32.2% had HFpEF, 14.5% HFmrEF, and 53.3% HFrEF. During 42 months of follow-up, 270 (29.9%) patients died and 545 (60.4%) patients experienced composite endpoints of death and HF readmission. The risk of all-cause death or composite endpoints was lower for HFpEF than HFrEF. Moreover, higher HbA1c variability was associated with higher all-cause mortality or composite endpoints and HbA1c variability was an independent predictor of all-cause mortality or composite endpoints, regardless of EF. This prospective longitudinal study showed that the all-cause death and composite events was lower for HFpEF than HFrEF. HbA1c variability was independently and similarly predictive of death or combined endpoints in the three HF phenotypes.