HbA1c trajectories predict risk of liver-related events in patients with T2DM
8 giờ trước
Time-weighted average haemoglobin A1c (HbA1c), cumulative duration of good glycaemic control, HbA1c variability, and HbA1c trajectories are all predictive of liver-related events (LREs) in patients with type 2 diabetes mellitus (T2DM), a study has found.
A team of investigators identified a territory-wide cohort of adults newly diagnosed with T2DM in Hong Kong. They also identified HbA1c trajectories using time-series clustering and validated these in the UK Biobank. Cause-specific hazards models were used to examine the relationship between HbA1c trajectories and LREs, with nonliver-related death as a competing risk.
A total of 294,096 patients (mean age 60.6 years, 50.6 percent males) were analysed, of whom 3,438 (1.2 percent) developed LREs over a median follow-up of 7.4 years.
Higher time-weighted average HbA1c (adjusted cause-specific hazard ratio [aCSHR], 1.12 per 1 percent, 95 percent confidence interval [CI], 1.08‒1.16; p<0.001) and greater HbA1c variability correlated with a higher LRE risk. On the other hand, more years with HbA1c <7 percent correlated with a lower risk (aCSHR, 0.95 per year, 95 percent CI, 0.93‒0.96; p<0.001).
Three trajectories were identified, namely rapid decreasing (n=43,712; 14.9 percent), mild decreasing (n=114,413; 38.9 percent), and increasing (n=135,971; 46.2 percent). Mild decreasing (aCSHR, 1.30, 95 percent CI, 1.13‒1.50; p<0.001) and increasing (aCSHR, 1.37, 95 percent CI, 1.16‒1.61; p<0.001) trajectories were associated with increased LRE risks compared with rapid decreasing trajectory.
Moreover, LRE risks were higher in patients with baseline HbA1c ≥9 percent and mild decreasing (aCSHR, 1.27, 95 percent CI, 1.08‒1.50; p<0.001) or increasing (aCSHR, 1.84, 95 percent CI, 1.45‒2.34; p<0.001) trajectories than those whose baseline HbA1c was <7 percent and with a mild decreasing trajectory.
On the other hand, patients with a rapid decreasing trajectory were not at increased risk of LRE (aCSHR, 1.05, 95 percent CI, 0.90‒1.22; p=0.57).
“A rapid decreasing trajectory may mitigate LRE risk in patients with high baseline HbA1c,” the investigators said.