Background: The relationship between glucose fluctuation and the risk of cardiovascular disease (CVD) in patients with diabetes remains elusive. Glycated hemoglobin (HbA1c) variability is a key parameter of glucose fluctuation.
Methods: PubMed, Cochrane Library, Web of Science, and Embase were searched up to 1 July 2022. Studies reporting associations of HbA1c variability (HbA1c-SD), coefficient of variation of HbA1c (HbA1c-CV), and HbA1c variability score [HVS] with the risk of CVD among patients with diabetes were included. We used three different insights (a high-low value meta-analysis, a study-specific meta-analysis, and a non-linear dose-response meta-analysis) to explore the relationship between HbA1c variability and CVD risk. A subgroup analysis was also performed to screen the potential confounding factors.
Results: A total of 14 studies with 254 017 patients with diabetes were eligible. The highest HbA1c variability was significantly associated with increased risks of CVD (HbA1c-SD, risk ratio [RR] 1.45; HbA1c-CV, RR 1.74; HVS, RR 2.46; all p < .001) compared to the lowest HbA1c variability. The RRs of CVD for per HbA1c variability were significantly >1 (all p < .001). The subgroup analysis for per HbA1c-SD found a significant exposure-covariate interaction in the types of diabetes (p = .003 for interaction). The dose-response analysis showed a positive association between HbA1c-CV and CVD risk (P for nonlinearity <.001).
Conclusions: Our study suggests that the higher glucose fluctuation is significantly associated with the higher CVD risk in diabetes patients based on HbA1c variability. The CVD risk associated with per HbA1c-SD might be higher among patients type 1 diabetes than patients with type 2 diabetes.
背景:血糖波动与糖尿病患者心血管疾病(CVD)风险的关系尚不清楚。糖化血红蛋白(HbA1c )变异性是反映血糖波动的关键指标。 方法:检索PubMed、Cochrane Library、Web of Science、Embase等数据库, 检索时间截至2022年7月1日。纳入HbA1c 变异性指标[HbA1c 标准差(HbA1c -SD)、HbA1c 变异系数(HbA1c - CV)和HbA1c 变异性评分(HVS)]与糖尿病患者CVD风险关联的研究。我们使用了三种不同的方式(高低值meta分析、针对特定研究的meta分析和非线性剂量-反应meta分析), 探讨HbA1c 变异性指标与CVD风险之间的关系, 并进行亚组分析, 以筛选潜在的混杂因素。 结果:共有14项涉及254017名糖尿病患者的研究符合条件。相比于HbA1c 变异性低的患者, HbA1c 变异性越高与CVD风险增加显著相关(HbA1c -SD, 风险比[RR] 1.45;HbA1c -CV, RR 1.74;HVS, RR 2.46;所有P <0.001)。每HbA1c变异性导致CVD的RRs均显著大于1(均P <0.001)。每HbA1c -SD亚组分析发现, 糖尿病类型的暴露-协变量存在显著的相互作用(相互作用P = 0.003)。剂量-反应分析显示HbA1c -CV与CVD风险呈正相关(非线性P<0.001)。 结论:基于HbA1c 变异性, 较高的血糖波动与糖尿病患者较高的CVD风险显著相关。与每HbA1c -SD相关的CVD风险在1型糖尿病患者中可能高于2型糖尿病患者。.
Keywords: HbA1c variability; HbA1c变异性; cardiovascular disease; diabetes; glucose fluctuation; meta-analysis; meta分析; 心血管疾病; 糖尿病; 葡萄糖波动.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.