The following is a summary of “Glycemic variability evaluated by HbA1c rather than fasting plasma glucose is associated with adverse cardiovascular events,” published in the February 2024 issue of Endocrinology by Sheng et al.

Researchers conducted a retrospective study to assess whether variability in hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) independently predict cardiovascular events in patients with type 2 diabetes mellitus (T2DM).

They analyzed the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Using Cox proportional hazards models, the association between HbA1c or FPG variability and the development of major adverse cardiovascular events (MACEs) was examined.

The results showed 9,547 patients diagnosed with T2DM with a median follow-up period of 4.6 ± 1.5 years, and 907 patients experienced MACEs. The risk of MACEs rose with increasing quartiles of HbA1c variability (P<0.01). Patients in the highest quartile had an HR of 1.37 (Model 2, 95% CI: 1.13–1.67) compared to those in the lowest quartile. Higher FPG variability did not correlate with increased MACE risk in T2DM patients (P for trend=0.28). A U-shaped relationship was observed between HbA1c/FPG variability and MACEs. The effect of glucose control therapy on the relationship between HbA1c and MACEs varied; individuals with higher HbA1c variability receiving intensive glucose control were more susceptible to MACEs (P for interaction <0.01).

Investigators concluded that with HbA1c and FPG variability in adults with T2DM, a U-shaped relationship with MACEs emerged, with elevated HbA1c variability (not FPG) significantly predicting events, especially under intensive glucose control strategies.

Source: frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1323571/full