Abstract 11051: Area under HbA1c Transition is Strongly Associated with the Development of Cardiovascular Events in Type2 Diabetic Patients

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major risk factor of cardiovascular diseases (CVD). Recent studies suggest that besides the level of hyperglycemia, the exposure period to hyperglycemia is an important risk factor for the development of CVD. The aim of this study is to create a new parameter to qualify the exposure period to hyperglycemia, which means accumulative glycemic control level.

Methods: We conducted a retrospective cohort study of 548 T2DM patients who have been followed for more than 4 years during the period from 22 July 2003 to 11 July 2011 at St. Luke’s International Hospital in Tokyo. We excluded patients who had been measured HbA1c less than 5 times per year and who had anemia. We calculated the area under HbA1c transition during first 3 years by the summation of each HbA1c × measurement time interval. We categorized the value of the area under HbA1c transition (x) into 3 groups; good control group <= 6600, moderate control group 6600< x < 7600, and poor control group whose value above 7600<=, respectively. Multivariate Cox proportional-hazards analysis was performed to reveal relevant attributable risk of each possible predictor for CVD which include coronary artery disease, cerebrovascular disease, and peripheral arterial disease.

Result: Area under HbA1c transition was significantly associated with CVD with adjustment of gender, age, hypertension, past medical history of CVD, smoking status, and the place where they were initiated DM therapy. Adjusted hazard ratio was good control group : HR 1.00 (ref), moderate control group : HR 2.64 [95%CI 1.19∼5.86], poor control group : HR 4.88 [95%CI 2.06∼11.53], respectively.

Conclusion: Area under HbA1c transition is strongly associated with the development of CVD, and it may be utilized as an useful predictive indicator for the prognosis of T2DM patients in clinical setting.