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Prognostic importance of baseline and serial glycated hemoglobin levels in high-risk patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study

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Abstract

The prognostic importance of baseline and serial glycated hemoglobin (HbA1c) changes for cardiovascular outcomes is still debated. We aimed to evaluate it in 620 high-risk individuals with type 2 diabetes (mean age 60.4 years, 37 % males, 55 % Caucasians). Patients had HbA1c levels measured at study entry and serially during follow-up. Primary end points were total cardiovascular events (CVEs), major CVEs (non-fatal myocardial infarctions and strokes plus cardiovascular deaths) and all-cause mortality. Cardiovascular and non-cardiovascular mortalities were secondary end points. HbA1c was evaluated either as a continuous variable and categorized at clinically relevant cutoffs. Multivariate Cox regressions assessed the associations with end points. After a median follow-up of 6.6 years, 125 total CVEs occurred (90 major CVEs), and 111 patients died (64 from cardiovascular diseases). After statistical adjustments for other cardiovascular risk factors, baseline and mean first-year HbA1c predicted all end points, except non-cardiovascular deaths; and hazard ratios tended to be higher for mean first year than for baseline HbA1c. Each 1 % (10.9 mmol/mol) increase in mean first-year HbA1c increased 27 % the risk of major CVEs occurrence (95 % CI 11–45 %). Updating HbA1c for values obtained beyond the second year of follow-up did not improve its predictive performance. The cardiovascular protection was observed until HbA1c values lower than 6.5 % (48 mmol/mol). Moreover, the magnitude of HbA1c reduction during the first year of follow-up was predictive of better cardiovascular outcomes, independent of baseline HbA1c levels. In conclusion, better glycemic control, especially during the first year of follow-up, is determinant of better cardiovascular outcomes in high-risk patients with type 2 diabetes, without any detectable lower threshold level of HbA1c.

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Acknowledgments

This study was supported by grants from Conselho Brasileiro de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ).

Conflict of interest

Claudia Cardoso declares that she has no conflict of interest in the manuscript. Nathalie Leite declares that she has no conflict of interest in the manuscript. Marcel Ferreira declares that he has no conflict of interest in the manuscript. Gil Salles declares that he has no conflict of interest in the manuscript.

Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Research Ethics Committee of the School of Medicine and University Hospital) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rua Croton 72 Jacarepagua, Rio de Janeiro, RJ, CEP: 22750-240, Brazil

    Claudia R. L. Cardoso, Nathalie C. Leite, Marcel T. Ferreira & Gil F. Salles

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  1. Claudia R. L. Cardoso
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  2. Nathalie C. Leite
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  3. Marcel T. Ferreira
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  4. Gil F. Salles
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Correspondence to Gil F. Salles.

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Cardoso, C.R.L., Leite, N.C., Ferreira, M.T. et al. Prognostic importance of baseline and serial glycated hemoglobin levels in high-risk patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study. Acta Diabetol 52, 21–29 (2015). https://doi.org/10.1007/s00592-014-0592-0

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  • DOI: https://doi.org/10.1007/s00592-014-0592-0

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