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Cheng W, Huang R, Pu Y, Li T, Bao X, Chen J, Li G, Wu H, Wei Z. Association between the haemoglobin glycation index (HGI) and clinical outcomes in patients with acute decompensated heart failure. Ann Med 2024; 56:2330615. [PMID: 38513606 PMCID: PMC10962296 DOI: 10.1080/07853890.2024.2330615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND A growing number of studies show that people with similar blood glucose levels have different levels of glycosylated haemoglobin (HbA1c), and relying only on HbA1c may lead to clinical decision-making errors. The haemoglobin glycation index (HGI) quantifies the difference in HbA1c among individuals and is strongly linked to the risk of cardiovascular disease. However, the connection between this phenomenon and the poor outcomes of patients with acute decompensated heart failure (ADHF) is currently unknown. PATIENTS AND METHODS This retrospective, single-centre-based cohort study included 1531 hospitalized patients with ADHF from September 2010 to January 2020. The HGI is calculated from the difference between the observed and predicted HbA1c values [predicted HbA1c = 0.024 × fasting plasma glucose (FPG) (mg/dL)+3.1]. The endpoints examined in the study included all-cause death, cardiovascular (CV) death, and major adverse cardiac events (MACE). We fitted multivariable-adjusted Cox proportional hazard models to investigate the association between the HGI and clinical outcomes. RESULTS During the five-year follow-up, 427 (27.9%) patients died from all causes, 232 (15.6%) from CV death, and 848 (55.4%) from MACE. The restricted cubic spline analysis also showed that the cumulative risk of all-cause and CV deaths decreased linearly with increasing HGI. According to multivariate Cox proportional hazard models, the highest tertile of the HGI was associated with a lower incidence of all-cause and cardiovascular deaths [all-cause death, adjusted hazard ratio (HR): 0.720, 95% confidence interval (CI): 0.563-0.921, p = 0.009; CV death, adjusted HR: 0.619, 95% CI: 0.445-0.861, p = 0.004]. A 1% increase in the HGI was associated with a 12.5% reduction in the risk of all-cause death and a 20.8% reduction in the risk of CV death. CONCLUSIONS A high HGI was directly associated with a reduction in all-cause and CV deaths but was not associated with MACE. These findings may be helpful in the management of patients with ADHF.
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Affiliation(s)
- Weimeng Cheng
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Rong Huang
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Yue Pu
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Tianyue Li
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Xue Bao
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Jianzhou Chen
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Guannan Li
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Han Wu
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Zhonghai Wei
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
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Yang J, Shangguan Q, Xie G, Yang M, Sheng G. Sex-specific associations between haemoglobin glycation index and the risk of cardiovascular and all-cause mortality in individuals with pre-diabetes and diabetes: A large prospective cohort study. Diabetes Obes Metab 2024; 26:2275-2283. [PMID: 38454654 DOI: 10.1111/dom.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
AIM The aim of this study was to investigate the relationship between the haemoglobin glycation index (HGI), and cardiovascular disease (CVD) and all-cause mortality in adults with pre-diabetes and diabetes. METHODS This study included 10 267 adults with pre-diabetes and diabetes from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Sex-differentiated relationships between HGI and mortality were elucidated using multivariate Cox proportional hazards models, restricted cubic splines and a two-piecewise Cox proportional hazards model. RESULTS During the median follow-up time of 103.5 months, a total of 535 CVD deaths and 1918 all-cause deaths were recorded. After multivariate adjustment, in males with pre-diabetes and diabetes, there was a U-shaped relationship between HGI and CVD mortality and all-cause mortality, with threshold points of -0.68 and -0.63, respectively. Before the threshold point, HGI was negatively associated with CVD mortality [hazard ratio (HR) 0.60; 95% confidence interval (CI) 0.41, 0.89] and all-cause mortality (HR 0.56; 95% CI 0.43, 0.74), and after the threshold point, HGI was positively associated with CVD mortality (HR 1.46; 95% CI 1.23, 1.73) and all-cause mortality (HR 1.40; 95% CI 1.23, 1.59). In contrast, HGI had an L-shaped relationship with all-cause mortality and no significant association with CVD mortality in females. To the left of the threshold points, the risk of all-cause mortality decreased (HR 0.50; 95% CI 0.35, 0.71) progressively with increasing HGI. CONCLUSIONS In the cohort study, HGI in pre-diabetic and diabetic populations was found to have a U-shaped association with CVD mortality and all-cause mortality in males and an L-shaped association with all-cause mortality only in females. Further prospective and mechanistic studies are warranted.
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Affiliation(s)
- Jingqi Yang
- Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Qing Shangguan
- Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Guobo Xie
- Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Ming Yang
- Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Guotai Sheng
- Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Shah VN, Kanapka LG, Karakus KE, Kollman C, Beck RW. The Association of High and Low Glycation With Incident Diabetic Retinopathy in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241254811. [PMID: 38805364 DOI: 10.1177/19322968241254811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND We investigated the risk of incident diabetic retinopathy (DR) among high glycator compared to low glycator patients based on the hemoglobin glycation index (HGI). Visit-to-visit variations in HGI also were assessed. METHODS Glycated hemoglobin (HbA1c) and continuous glucose monitoring data were collected up to 7 years prior to the date of eye examination defining incident DR or no retinopathy (control). Hemoglobin glycation index was calculated as difference in measured HbA1c and an estimated A1c from sensor glucose (eA1c) to define high (HbA1c - eA1c >0%) or low (HbA1c - eA1c <0%) glycator. Stable glycators were defined as ≥75% of visits with same HGI category. Logistic regression was used to assess the association between glycation category and incident DR. RESULTS Of 119 adults with type 1 diabetes (T1D), 49 (41%) were stable low glycator (HbA1c - eA1c <0%), 36 (30%) were stable high glycator (HbA1c - eA1c >0%), and 34 (29%) were unstable glycator. Using alternate criteria to define high vs low glycator (consistent difference in HbA1c - eA1c of > 0.4% or <0.4%, respectively), 53% of the adults were characterized as unstable glycator. Compared to low glycators, high glycators did not have a significantly higher risk for incident DR over time when adjusted for age, T1D duration and continuous glucose monitoring (CGM) sensor type (odds ratio [OR] = 1.31, 95% confidence interval [CI] = 0.48-3.62, P = .15). CONCLUSIONS The risk of diabetic retinopathy was not found to differ significantly comparing high glycators to low glycators in adults with T1D. Moreover, HbA1c - eA1c relationship was not stable in nearly 30% to 50% adults with T1D, suggesting that discordance in HbA1c and eA1c are mostly related either HbA1c measurements or estimation of A1c from sensor glucose rather than physiological reasons.
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Affiliation(s)
- Viral N Shah
- Division of Endocrinology & Metabolism and Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Kagan Ege Karakus
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
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Wei X, Chen X, Zhang Z, Wei J, Hu B, Long N, Feng J, Luo C. Risk analysis of the association between different hemoglobin glycation index and poor prognosis in critical patients with coronary heart disease-A study based on the MIMIC-IV database. Cardiovasc Diabetol 2024; 23:113. [PMID: 38555454 PMCID: PMC10981833 DOI: 10.1186/s12933-024-02206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/16/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The hemoglobin glycation index (HGI) is the difference between the observed and predicted values of glycosylated hemoglobin (HbA1c), which is closely associated with a variety of poor prognoses. However, there are still no studies on the correlation between HGI and poor prognosis in patients with critical coronary artery disease. The purpose of this study was to analyze the correlation between HGI and all-cause mortality in patients with critical coronary artery disease using the MIMIC-IV database. METHODS The HGI was calculated by constructing a linear regression equation between HbA1c and fasting plasma glucose (FPG). A Kaplan‒Meier survival analysis model was constructed based on the HGI quartiles to clarify the differences in all-cause mortality rates between groups, and the log-rank test was used to assess the differences between groups. The hazard ratio (HR) of HGI as a risk factor for outcome events was assessed using the Cox proportional risk model and restricted cubic spline (RCS), with the Q2 group serving as the reference group. RESULTS A total of 5260 patients were included in this study. The 30-day mortality rate of the patients was 4.94% and the mortality rate within 365 days was 13.12%. A low HGI was significantly associated with 30-day mortality (HR, 1.96; 95% CI, (1.38, 2.78); P < 0.001) and 365-day mortality (HR, 1.48; 95% CI, (1.19, 1.85); P < 0.001) in patients with critical coronary artery disease in the completely adjusted Cox proportional risk model. In addition, high levels of HGI were associated with 365-day mortality (HR, 1.31; 95% CI, (1.02, 1.69); P < 0.05). RCS analysis revealed a U-shaped relationship between HGI and outcome events. According to the stratified analysis, the interaction test revealed that the correlation between HGI and outcome events remained stable. CONCLUSION There was a significant correlation between HGI and all-cause mortality in patients with critical coronary artery disease, particularly in those with low HGI. HGI can be used as a potential indicator for assessing the short- and long-term risk of mortality in such patients.
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Affiliation(s)
- Xing Wei
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xinghua Chen
- The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China
- Intensive Care Unit, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, China
| | - Zhipeng Zhang
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jing Wei
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Ben Hu
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Nv Long
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jun Feng
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Chunmiao Luo
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China.
- The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China.
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Chen J, Lin S, Wang X, Wang X, Gao P. Lower Dietary Magnesium Is Associated with a Higher Hemoglobin Glycation Index in the National Health and Nutrition Examination Survey. Biol Trace Elem Res 2024; 202:878-884. [PMID: 37294398 DOI: 10.1007/s12011-023-03727-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
The data for the effect of dietary magnesium (Mg) on hemoglobin glycation index (HGI) is limited. Thus, this study aimed to examine the relationship between dietary Mg and HGI in the general population. Our research used data from the National Health and Nutrition Examination Survey from 2001 to 2002. The dietary intake of Mg was assessed by two 24-h dietary recalls. The predicted HbA1c was calculated based on fasting plasma glucose. Logistic regression and restricted cubic spline models were applied to assess the relationship between dietary Mg intake and HGI. We found a significant inverse association between dietary Mg intake and HGI (β = - 0.00016, 95%CI: - 0.0003, - 0.00003, P = 0.019). Dose-response analyses revealed that HGI decreased with increasing intakes of Mg when reached the point above 412 mg/day. There was a linear dose-response relationship between dietary Mg intake and HGI in diabetic subjects, and there was an L-shape dose-response relationship in non-diabetic individuals. Increasing the intake of Mg might help lower the risk associated with high HGI. Further prospective studies are requested before dietary recommendations.
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Affiliation(s)
- Juan Chen
- Department of Endocrinology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, China.
| | - Song Lin
- Department of Clinical Nutrition, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, China
| | - Xingzhou Wang
- Department of Endocrinology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, China
| | - Xiwei Wang
- Department of Mathematics, The University of Liverpool, Liverpool, UK
| | - Pengxia Gao
- Department of Endocrinology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, China.
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Cheng MD, Tang JN, Liu ZY, Guo QQ, Zhang JC, Zhang ZL, Song FH, Wang K, Jiang LZ, Fan L, Yue XT, Bai Y, Dai XY, Zheng RJ, Zheng YY, Zhang JY. Association of hemoglobin glycation index with prognosis of coronary artery disease after percutaneous coronary intervention: A retrospective cohort study. Diab Vasc Dis Res 2023; 20:14791641231193306. [PMID: 37561132 PMCID: PMC10416663 DOI: 10.1177/14791641231193306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
AIMS To analyze the association between hemoglobin glycation index (HGI) and the long-term prognosis of patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). METHODS Predicted glycated hemoglobin (HbA1c) level was calculated using an established formula and HGI represented the difference between laboratory measured HbA1c and predicted HbA1c. A total of 1780 patients were stratified into three subgroups (HGI < -0.4, -0.4 ≦ HGI < 0.12 and HGI ≧ 0.12). The primary endpoints included all-cause mortality (ACM) and cardiac mortality (CM). The secondary endpoints were major adverse cardiac events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs). RESULTS ACM occurred in 54 patients: 22 (3.7) in the low-HGI subgroup, 8 (1.3) in the moderate-HGI subgroup and 24 (4.1) in the high-HGI subgroup (p = .012). After adjusting for the traditional clinical prognostic factors, multivariate Cox regression analysis showed that patients in both the low and high HGI subgroups had significantly increased risk of ACM as compared with patients in the moderate HGI subgroup (hazard ratio [HR] = 4.979, 95% confidence interval [CI]: 1.865-13.297, p = .001 and HR = 2.918, 95% CI: 1.075-7.922, p = .036). However, we did not find significant differences in the incidence of CM, MACEs and MACCEs. CONCLUSION HGI can predicts risk for long-term mortality in patients undergoing PCI. This index could be helpful for the effective clinical management of the CAD population.
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Affiliation(s)
- Meng-Die Cheng
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun-Nan Tang
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhi-Yu Liu
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian-Qian Guo
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian-Chao Zhang
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zeng-Lei Zhang
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng-Hua Song
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Wang
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li-Zhu Jiang
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Fan
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-Ting Yue
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Bai
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-Ya Dai
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ru-Jie Zheng
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jin-Ying Zhang
- Department of Cardiology, Key Laboratory of Cardiac Injury and Repair of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Xin S, Zhao X, Ding J, Zhang X. Association between hemoglobin glycation index and diabetic kidney disease in type 2 diabetes mellitus in China: A cross- sectional inpatient study. Front Endocrinol (Lausanne) 2023; 14:1108061. [PMID: 36967789 PMCID: PMC10031087 DOI: 10.3389/fendo.2023.1108061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Objective To investigate the association between Hemoglobin Glycation Index (HGI) and Diabetic Kidney Disease (DKD) in Chinese type 2 diabetic individuals and to construct a risk score based on HGI to predict a person's risk of DKD. Methods We retrospectively analyzed 1622 patients with type 2 diabetes mellitus (T2DM). HGI was obtained by calculating the fasting plasma glucose (FPG) level into the formula, and they were grouped into low HGI group (L-HGI), medium HGI group (H-HGI) and high HGI group (H-HGI) according to tri-sectional quantile of HGI. The occurrence of DKD was analyzed in patients with different levels of HGI. Multivariate logistics regression analysis was used to analyze the risk factors of DKD in patients with T2DM. Results A total of 1622 patients with T2DM were enrolled in the study. Among them, 390 cases were DKD. The prevalence of DKD among the three groups was 16.6%, 24.2% and 31.3%. The difference was statistically significant (P = 0.000). There were significant differences in age (P=0.033), T2DM duration (P=0.005), systolic blood pressure (SBP) (P=0.003), glycosylated hemoglobin (HbA1c) (P=0.000), FPG (P=0.032), 2-hour postprandial plasma glucose (2h-PPG) (P=0.000), fasting C-peptide FCP (P=0.000), 2-hour postprandial C-peptide (2h-CP) (P=0.000), total cholesterol (TC) (P=0.003), low density lipoprotein cholesterol (LDL-C) (P=0.000), serum creatinine (sCr) (P=0.001), estimated glomerular filtration rate (eGFR) (P=0.000) among the three groups. Mantel-Haenszel chi-square test showed that there was a linear relationship between HGI and DKD (x2=177.469, p < 0.001). Pearson correlation analysis showed that with the increase of HGI level the prevalence of DKD was increasing (R= 0.445, P=0.000). It was indicated by univariate logistic regression analysis that individuals in H-HGI was more likely to develop DKD (OR: 2.283, 95% CI: 1.708~ 3.052) when compared with L-HGI. Adjusted to multiple factors, this trend still remained significant (OR: 2.660, 95% CI: 1.935~ 3.657). The combined DKD risk score based on HGI resulted in an area under the receiver operator characteristic curve (AUROC) of 0.702. Conclusions High HGI is associated with an increased risk of DKD. DKD risk score may be used as one of the risk predictors of DKD in type 2 diabetic population.
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Affiliation(s)
- Sixu Xin
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Xin Zhao
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Jiaxiang Ding
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Xiaomei Zhang
- Department of Endocrinology, Peking University International Hospital, Beijing, China
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Chen X, Zhang X, Gong Z, Yang Y, Zhang X, Wang Q, Wang Y, Xie R. The link between diabetic retinal and renal microvasculopathy is associated with dyslipidemia and upregulated circulating level of cytokines. Front Public Health 2023; 10:1040319. [PMID: 36733289 PMCID: PMC9886881 DOI: 10.3389/fpubh.2022.1040319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Purpose To investigate the mechanisms underlying the correlations between diabetic retinopathy (DR) and diabetic nephropathy (DKD) and examine whether circulating cytokines and dyslipidemia contribute to both DR and DKD in patients with 2 diabetes mellitus (T2DM). Methods A total of 122 patients with T2DM were enrolled and categorized into the DM group (without no DR and DKD), DR group [non-proliferative DR (NPDR), and proliferative DR (PDR)] with no DKD), DR complicated with DKD groups (DR+DKD group). The biochemical profile, including fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and lipid profile were estimated, and plasma inflammatory and angiogenic cytokines [monocyte chemoattractant protein-1 (MCP-1), interleukin (IL)-6, IL-8, vascular endothelial growth factor (VEGF)-A, C, D, and placental growth factor (PlGF)] were analyzed by protein microarrays. The atherogenic plasma index (API) was defined as low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein-cholesterol (HDL-C); atherogenic index (AI) was calculated as [(total cholesterol (TC) -HDL-C)/HDL-C], and atherogenic index of plasma (AIP) was defined as log (TG/HDL-C). Results By multivariable disordered regression analysis, after controlling for duration of DM and hypertension, LDL-C (p = 0.019) and VEGF-D (p = 0.029) resulted as independent risk factors for DR. Albumin-to-creatinine ratio (uACR) (p = 0.003) was an independent risk factor for DR with DKD. In DR, NPDR, and PDR groups, grades of A1, A2, and A3 of albuminuria increased with the severity of DR. In A1, A2, and A3 grade groups, the severity of DR (DM, NPDR, and PDR) increased with higher albuminuria grades. Kendall's tau-b correlation coefficient analysis revealed that FBG (p = 0.019), circulating level of PlGF (p = 0.002), and VEGF-D (p = 0.008) were significantly positively correlated with the grades of uACR (p < 0.001), and uACR grades were significantly correlated with DR severity (p < 0.001). Conclusions The occurrence and severity of DR are closely correlated with kidney dysfunction. Among the three kidney functional parameters, uACR resulted as the better indicator of DR severity and progression than glomerular filtration (eGFR) and serum creatinine (Scr). Impaired FBG was associated with microalbuminuria, emphasizing that well-controlled FBG is important for both DR and DKD. The link between diabetic retinal and renal microvasculopathy was associated with dyslipidemia and upregulated circulating level of angiogenic cytokines.
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Affiliation(s)
- Xiaosi Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Xinyuan Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China,*Correspondence: Xinyuan Zhang ✉
| | - Zhizhong Gong
- Division of Medical Affairs, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yang Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Xiaohong Zhang
- Clinical Laboratory of Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiyun Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, School of Basic Medicine, Peking Union Medical College, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
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Wang J, Zhang L, bai Y, Wang X, Wang W, Li J, Zhou S. The influence of shorter red blood cell lifespan on the rate of HbA1c target achieved in type 2 diabetes patients with a HbA1c detection value lower than 7. J Diabetes 2023; 15:7-14. [PMID: 36541364 PMCID: PMC9870739 DOI: 10.1111/1753-0407.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/14/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Variations in the red blood cell (RBC) lifespan can affect glycosylated hemoglobin (HbA1c) test values, but there is still a lack of evidence regarding how and to what degree the RBC lifespan influences HbA1c in the type 2 diabetes mellitus (T2DM) population owing to the restriction of traditional RBC lifespan-detection means. This study aimed to investigate the influence of RBC lifespan variation on HbA1c values in T2DM patients with a HbA1c detection value lower than 7%. METHODS Patients with HbA1c <7% were divided into two groups: RBC lifespan <90 days and RBC lifespan ≥90 days. We collected blood glucose levels at seven time points for three consecutive months, assessed the HbA1c and glycosylated albumin levels, and calculated the hemoglobin glycation index (HGI) for each patient. RESULTS There were no statistical differences in the HbA1c value between two groups, but the estimated glycosylated hemoglobin (eHbA1c) was significantly higher in patients with an RBC lifespan <90 days. The proportion of the eHbA1c ≥7% in the group with an RBC lifespan <90 days was significantly higher than the other group (33.87% vs. 12.50%, p < .01). Pearson analysis showed a significant negative correlation between RBC lifespan and the HGI in patients with T2DM (r = -0.348, p < .01). CONCLUSION A reduced RBC lifespan in T2DM patients caused a noticeable underestimate of the blood glucose levels as presented by HbA1c detection value.
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Affiliation(s)
- Junmei Wang
- NHC Key Laboratory of Hormones and DevelopmentChu Hsien‐I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Metabolic DiseasesTianjin Medical UniversityTianjinChina
| | - Li Zhang
- NHC Key Laboratory of Hormones and DevelopmentChu Hsien‐I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Metabolic DiseasesTianjin Medical UniversityTianjinChina
| | - Yu bai
- NHC Key Laboratory of Hormones and DevelopmentChu Hsien‐I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Metabolic DiseasesTianjin Medical UniversityTianjinChina
| | - Xinli Wang
- NHC Key Laboratory of Hormones and DevelopmentChu Hsien‐I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Metabolic DiseasesTianjin Medical UniversityTianjinChina
| | - Weilin Wang
- NHC Key Laboratory of Hormones and DevelopmentChu Hsien‐I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Metabolic DiseasesTianjin Medical UniversityTianjinChina
| | - Jing Li
- NHC Key Laboratory of Hormones and DevelopmentChu Hsien‐I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Metabolic DiseasesTianjin Medical UniversityTianjinChina
| | - Saijun Zhou
- NHC Key Laboratory of Hormones and DevelopmentChu Hsien‐I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Metabolic DiseasesTianjin Medical UniversityTianjinChina
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10
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Lin L, Wang A, Jia X, Wang H, He Y, Mu Y, Dou J. High hemoglobin glycation index is associated with increased risk of diabetes: A population-based cohort study in China. Front Endocrinol (Lausanne) 2023; 14:1081520. [PMID: 36909319 PMCID: PMC9999023 DOI: 10.3389/fendo.2023.1081520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
PURPOSE The hemoglobin glycation index (HGI) quantifies the mismatch between glycated hemoglobin A1c and average glycemia among individuals. Currently, it is unknown the potential role of HGI in exhaustively evaluating the progression of glucose metabolism/the risk of developing diabetes mellitus. Therefore, this study aimed to investigate the association between HGI and the risk of incident diabetes. METHODS A total of 7,345 participants aged at least 40 years and without diabetes were divided into three groups according to the tertile of their baseline HGI level and followed for a median of 3.24 years to track new-onset diabetes. Using multivariate Cox regression analyses, we explored the association between the HGI, both categorized and continuous, and incident diabetes. RESULTS During follow-up, 742 subjects (263 males and 479 females) developed diabetes mellitus. Higher HGI was associated with an increased risk of diabetes, even when adjusted for confounding factors, and every standard deviation increase in HGI was associated with a significant risk increase of 30.6% for diabetes (hazard ratio 1.306, 95% confidence interval 1.232-1.384). CONCLUSIONS Participants with a higher HGI were at a higher risk of future diabetes, irrespective of their glycemic conditions. Consequently, HGI may be employed to identify individuals at high risk for diabetes.
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Affiliation(s)
- Lu Lin
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Anping Wang
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiaomeng Jia
- Center for Endocrine Metabolism and Immune Disease, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Haibin Wang
- Department of endocrinology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
- Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yiming Mu
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jingtao Dou
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Jingtao Dou,
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Mei Y, Li A, Zhao J, Zhou Q, Zhao M, Xu J, Li R, Li Y, Li K, Ge X, Guo C, Wei Y, Xu Q. Association of long-term air pollution exposure with the risk of prediabetes and diabetes: Systematic perspective from inflammatory mechanisms, glucose homeostasis pathway to preventive strategies. ENVIRONMENTAL RESEARCH 2023; 216:114472. [PMID: 36209785 DOI: 10.1016/j.envres.2022.114472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/29/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Limited evidence suggests the association of air pollutants with a series of diabetic cascades including inflammatory pathways, glucose homeostasis disorder, and prediabetes and diabetes. Subclinical strategies for preventing such pollutants-induced effects remain unknown. METHODS We conducted a cross-sectional study in two typically air-polluted Chinese cities in 2018-2020. One-year average PM1, PM2.5, PM10, SO2, NO2, and O3 were calculated according to participants' residence. GAM multinomial logistic regression was performed to investigate the association of air pollutants with diabetes status. GAM and quantile g-computation were respectively performed to investigate individual and joint effects of air pollutants on glucose homeostasis markers (glucose, insulin, HbA1c, HOMA-IR, HOMA-B and HOMA-S). Complement C3 and hsCRP were analyzed as potential mediators. The ABCS criteria and hemoglobin glycation index (HGI) were examined for their potential in preventive strategy. RESULTS Long-term air pollutants exposure was associated with the risk of prediabetes [Prevalence ratio for O3 (PR_O3) = 1.96 (95% CI: 1.24, 3.03)] and diabetes [PR_PM1 = 1.18 (95% CI: 1.05, 1.32); PR_PM2.5 = 1.08 (95% CI: 1.00, 1.16); PR_O3 = 1.35 (95% CI: 1.03, 1.74)]. PM1, PM10, SO2 or O3 exposure was associated with glucose-homeostasis disorder. For example, O3 exposure was associated with increased levels of glucose [7.67% (95% CI: 1.75, 13.92)], insulin [19.98% (95% CI: 4.53, 37.72)], HOMA-IR [34.88% (95% CI: 13.81, 59.84)], and decreased levels of HOMA-S [-25.88% (95% CI: -37.46, -12.16)]. Complement C3 and hsCRP played mediating roles in these relationships with proportion mediated ranging from 6.95% to 60.64%. Participants with HGI ≤ -0.53 were protected from the adverse effects of air pollutants. CONCLUSION Our study provides comprehensive insights into air pollutant-associated diabetic cascade and suggests subclinical preventive strategies.
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Affiliation(s)
- Yayuan Mei
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jiaxin Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Quan Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Runkui Li
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, 100049, China; State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China
| | - Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Kai Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Xiaoyu Ge
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Chen Guo
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environment Sciences, Beijing, 100012, China
| | - Yongjie Wei
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environment Sciences, Beijing, 100012, China.
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China.
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12
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Mohan V, Wangnoo S, Das S, Dhediya R, Gaurav K. Comparison of gliclazide vs linagliptin on hypoglycemia and cardiovascular events in type 2 diabetes mellitus: A systematic review. World J Diabetes 2022; 13:1168-1183. [PMID: 36578872 PMCID: PMC9791565 DOI: 10.4239/wjd.v13.i12.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/20/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride (a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin. Gliclazide (another newer sulfonylureas) has shown similar glycemic efficacy and 50% decreased risk of hypoglycemia compared to glimepiride.
AIM Considering the absence of cardiovascular outcome trials for gliclazide, we decided to conduct a systematic review of the literature to assess the car-diovascular (CV) safety by assessing the risk for major adverse CV events and hypoglycemia risk of gliclazide vs linagliptin in patients with type 2 diabetes (T2D).
METHODS This systematic review followed the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to analyze all the clinical studies published from 2008 that compared the two drugs in patients with T2D with no risk of CV disease (CVD). We included only evidence designated high quality by the Oxford Center for Evidence-based Medicine-Levels of Evidence.
RESULTS Eight clinical studies were included in the narrative descriptive analysis (gliclazide: 5 and linagliptin: 3). The CV safety of gliclazide in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial and of linagliptin in the Cardiovascular and Renal Microvascular Outcome Study With Linagliptin (CARMELINA) and CARdiovascular Outcome study of LINAgliptin vs glimepiride in patients with T2D (CAROLINA) trials were excluded from the comparative analysis as these trials demonstrated CV and hypoglycemia benefits in patients at high risk of CVD. However, since these are landmark trials, they were discussed in brief to show the CV benefits and low hypoglycemia risk of gliclazide and linagliptin. We did not find any study comparing gliclazide with linagliptin. Hence, direct comparison of their major adverse CV events and hypoglycemia risk could not be carried out. However, the literature meeting the inclusion criteria showed that both drugs were effective in achieving the desired glycemic control and had low major adverse CV events and hypoglycemia risk in adult patients with no history of CVD.
CONCLUSION Gliclazide can be considered an effective and safe glucose-lowering drug in T2D patients with no established CVD but at high risk of CVD due to their T2D status. Future randomized controlled trials comparing gliclazide with linagliptin or dipeptidyl peptidase-4 inhibitors can confirm these findings.
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Affiliation(s)
- Viswanathan Mohan
- Department of Diabetes, Madras Diabetes Research Foundation & Dr Mohan’s Diabetes Specialties Centre, Chennai 600086, Tamil Nadu, India
| | - Subhash Wangnoo
- Department of Diabetes, Apollo Hospital Education and Research Foundation, New Delhi 110001, India
| | - Sambit Das
- Department of Endocrinology, Endeavour Clinics, Bhubaneswar 750017, India
| | - Rajnish Dhediya
- Medical Affairs, Dr. Reddy’s Laboratories Ltd, Hyderabad 500016, India
| | - Kumar Gaurav
- Medical Affairs, Dr. Reddy’s Laboratories Ltd, Hyderabad 500016, India
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Xu S, Qin Z, Yuan R, Cui X, Zhang L, Bai J, Liu G, Wang Z, Yu F, Lv Y, Zhang J, Tang J. The hemoglobin glycation index predicts the risk of adverse cardiovascular events in coronary heart disease patients with type 2 diabetes mellitus. Front Cardiovasc Med 2022; 9:992252. [PMID: 36407464 PMCID: PMC9668857 DOI: 10.3389/fcvm.2022.992252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background Previous studies have shown that the hemoglobin glycation index (HGI) can be used as a predictor of diabetic complications. However, limited information is currently available to indicate the correlation between HGI and comorbidity of coronary heart disease (CHD) and diabetes. This study aimed to evaluate the potential of HGI to predict major adverse cardiovascular events (MACEs) in CHD patients with type 2 diabetes mellitus (T2DM) undergoing percutaneous coronary intervention (PCI). Materials and methods A total of 918 CHD patients with T2DM were enrolled in a 3-year retrospective cohort study, from December 2017 to December 2020 at the First Affiliated Hospital of Zhengzhou University. Data including fasting blood glucose (FPG/FBG) and glycated hemoglobin A1c (HbA1c) were collected. HGI was calculated as actual measured HbA1c minus predicted HbA1c. Three groups were further divided based on the levels of HGI, including low, medium, and high levels. Result Kaplan Meier analysis indicated that elevated HGI was strongly associated with the occurence of MACE (log-rank P < 0.001). Multivariate Cox regression analysis revealed that elevated HGI was an independent risk factor for incident MACE in CHD patients with T2DM [adjusted hazard ratio (HR): 1.473; 95% confidence interval (CI): 1.365-1.589, P < 0.001]. Conclusions Hemoglobin glycation index is an independent predictor of MACE events in CHD patients with T2DM. High HGI indicates a higher risk of MACE occurrence.
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Affiliation(s)
- Shuai Xu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Zhen Qin
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Ruixia Yuan
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaolin Cui
- School of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Bone and Joint, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Li Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Jing Bai
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Gangqiong Liu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Zeyu Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Fengyi Yu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Yan Lv
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Jinying Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
- Jinying Zhang,
| | - Junnan Tang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
- *Correspondence: Junnan Tang,
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Li J, Xin Y, Li J, Zhou L, Qiu H, Shen A, Chen H, Li H. Association of haemoglobin glycation index with outcomes in patients with acute coronary syndrome: results from an observational cohort study in China. Diabetol Metab Syndr 2022; 14:162. [PMID: 36316759 PMCID: PMC9620631 DOI: 10.1186/s13098-022-00926-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The hemoglobin glycation index (HGI) is the difference between measured and estimated glycation of hemoglobin. However, there is limited evidence to investigate the HGI and the clinical outcomes of acute coronary syndrome patients. This study aimed to evaluate the association between HGI and the clinical outcomes of acute coronary syndrome (ACS) in a China cohort. METHOD This single-center retrospective study was carried out in the Cardiovascular Center of Beijing Friendship Hospital, a total of 11004 consecutive patients with ACS from Dec 2012-Dec 2020 were enrolled in this study. Patients were divided into quintiles according to their HGI levels. The incidence of major adverse cardiac and cerebrovascular events (MACCEs) was recorded. RESULT HGI were divided into five quintiles quintiles: -0.906 (-7.188, -0.663), -0.491 (-0.663, -0.343), -0.196 (-0.342, -0.039), 0.170 (-0.039, 0.485), and 1.156 (0.485, 7.875), respectively. Competing risk regression revealed that HGI was positively related to all-cause death, CV death, and composite MACCEs. Multivariate Cox proportional hazards regression analysis indicated that hypertension (HR:1.109, P = 0.013), previous stroke (HR:1.208, P < 0.001), past PCI (HR: 1.268, P < 0.001), age (HR: 1.011, P < 0.001), BMI (HR: 0.987, P = 0.012), heart rate (HR: 1.004, P = 0.001), NSTEMI (HR: 1.205, P < 0.001), WBC (HR: 1.020, P = 0.008), eGFR (HR: 0.993, P < 0.001), HDL-C (HR: 0.809, P = 0.002), LVEF (HR:0.240, P < 0.001), LM/three-vessel or proximal LAD involved (HR: 1.208 P < 0.001; HR:0.914, P = 0.019, respectively), and antiplatelet agents during hospitalization (HR:0.806, P = 0.020) independently predicted the incidence of MACCEs in ACS patients. Restricted cubic spline indicated a U-shaped association between the HGI and risk of MACCEs. CONCLUSION Both low HGI and high HGI was associated with an increased risk of adverse outcomes in patients with acute coronary syndrome, compared with moderate HGI.
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Affiliation(s)
- Jiayu Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University. No, 95 Yong’an Road, Xicheng District, Beijing, 100050 China
| | - Yanguo Xin
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University. No, 95 Yong’an Road, Xicheng District, Beijing, 100050 China
| | - Jingye Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University. No, 95 Yong’an Road, Xicheng District, Beijing, 100050 China
| | - Li Zhou
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University. No, 95 Yong’an Road, Xicheng District, Beijing, 100050 China
| | - Hui Qiu
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University. No, 95 Yong’an Road, Xicheng District, Beijing, 100050 China
| | - Aidong Shen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University. No, 95 Yong’an Road, Xicheng District, Beijing, 100050 China
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University. No, 95 Yong’an Road, Xicheng District, Beijing, 100050 China
| | - Hongwei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University. No, 95 Yong’an Road, Xicheng District, Beijing, 100050 China
- Department of Internal Medical, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
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Wang P, Li Q, Guo X, Zhou Y, Li Z, Yang H, Yu S, Sun Y, Zhang X. The Value of Hemoglobin Glycation Index-Diabetes Mellitus System in Evaluating and Predicting Incident Stroke in the Chinese Population. J Clin Med 2022; 11:jcm11195814. [PMID: 36233695 PMCID: PMC9573704 DOI: 10.3390/jcm11195814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
We aimed to clarify the effect of the hemoglobin glycation index (HGI)–diabetes mellitus (DM) system in evaluating the risk of incident stroke. We followed up on 2934 subjects in rural regions of Northeast China, established Cox proportional hazards models to evaluate the effects of the HGI–DM system in describing stroke risk, and further conducted a discrimination analysis to confirm the improvement in HGI based on the traditional stroke risk model. After a median of 4.23 years of follow-up, 79 subjects developed stroke or related death. DM-high HGI condition significantly elevated the risk of incident stroke (hazard ratio (HR): 2.655, 95% confidence interval (CI): 1.251–5.636). In addition, higher HGI levels elevated the risk of stroke, even if the patients did not have DM (HR: 1.701, 95% CI: 1.136–2.792), but DM failed to bring an extra risk of incident stroke to patients with lower HGI levels (HR: 1.138, 95% CI: 0.337–3.847). The discrimination analysis indicated that the integrated discrimination index (IDI) of the HGI model was 0.012 (95% CI: 0.007–0.015) and that the net reclassification index (NRI) was 0.036 (95% CI: 0.0198–0.0522). These results indicated HGI was associated with the onset of stroke, and high HGI indicated an aggravated trend in glycemic status and increased risk of incident stroke. The HGI–DM system enabled us to identify the different glucose statuses of patients, to conduct suitable treatment strategies, as well as to improve the predictability of incident stroke based on the traditional model.
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Wang S, Gu L, Chen J, Jiang Q, Sun J, Wang H, Wang L. Association of hemoglobin glycation index and glycation gap with cardiovascular disease among US adults. Diabetes Res Clin Pract 2022; 190:109990. [PMID: 35820564 DOI: 10.1016/j.diabres.2022.109990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/16/2022] [Accepted: 07/06/2022] [Indexed: 01/01/2023]
Abstract
AIMS To investigate the association of hemoglobin glycation index (HGI) and glycation gap (GGap), reflecting mismatches between HbA1c and other measures of glycemia, with cardiovascular disease (CVD) in the general population. METHODS 5966 US adult (age ≥ 20 years) participants were included from the National Health and Nutrition Examination Survey (NHANES) (1999-2004). In this cross-sectional study, predicted HbA1c was calculated based on fasting plasma glucose (FPG) and glycated albumin (GA), respectively. Multivariable binary logistic regression analysis was performed to explore the association of HGI and GGap with CVD prevalence. RESULTS Compared to the lowest tertile, the ORs with 95% CIs for CVD across the tertiles were 1.41 (1.01, 1.96) and 0.87 (0.58, 1.31) for HGI (P for trend = 0.535) and 1.06 (0.77, 1.47) and 1.60 (1.18, 2.17) for GGap (P for trend = 0.002) in the fully-adjusted model. Besides, the discordantly high GGap/low HbA1c group was associated with higher CVD prevalence compared with the low GGap/high HbA1c group (OR = 1.50, 95% CI, 1.04-2.16, P = 0.030). CONCLUSIONS GGap derived from GA is associated with CVD independent of traditional risk factors, even HbA1c, in US general adults. Considering the potential limitations of HbA1c, the introduction of GGap is warranted.
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Affiliation(s)
- Sibo Wang
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Lingfeng Gu
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Jiawen Chen
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Qiqi Jiang
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Jiateng Sun
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Hao Wang
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Liansheng Wang
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China.
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Abstract
A high hemoglobin glycation index (HGI) has been repeatedly associated with greater risk for hypoglycemia in people with diabetes and greater risk for chronic vascular disease in people with or without diabetes. This review explores how different sources of analytical and biological variation in HbA1c and blood glucose individually and collectively affect the clinical information value of HGI. We conclude that HGI is a complex quantitative trait that is a clinically practical biomarker of risk for both hypoglycemia and chronic vascular disease.
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Affiliation(s)
- James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Staimez LR, Kipling LM, Nina Ham J, Legvold BT, Jackson SL, Wilson PWF, Rhee MK, Phillips LS. Potential misclassification of diabetes and prediabetes in the U.S.: Mismatched HbA1c and glucose in NHANES 2005-2016. Diabetes Res Clin Pract 2022; 189:109935. [PMID: 35662612 PMCID: PMC10148706 DOI: 10.1016/j.diabres.2022.109935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/13/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
AIMS To assess the prevalence and clinical implications of "mismatches" between HbA1c and glucose levels in the United States across the life course. METHODS Participants ages 12-79 years from U.S. National Health and Nutrition Examination Survey (NHANES) 2005-2016 without known diagnosis of diabetes and who had a 75 g oral glucose tolerance test were included. Previously undiagnosed diabetes (DM), prediabetes, and normal glucose metabolism (NGM) were defined using American Diabetes Association cut-points. Mismatches were defined by the hemoglobin glycation index (HGI). RESULTS In 10,361 participants, 5% and 41% had diabetes and prediabetes, respectively, by fasting or 2-hour glucose criteria. By HbA1c criteria, the high HGI tertile consisted of mostly abnormal classification (3% DM, 52% prediabetes) and the low HGI tertile contained mostly normal classification (78% NGM). Across all ages, 15% (weighted: 30 million individuals) had clinically significant mismatches of HGI magnitude ≥+0.5% (i.e., high mismatch) or ≤-0.5% (low mismatch). Mismatch was most common in older adults and non-Hispanic Black participants. CONCLUSIONS Mismatches of clinically significant magnitude could lead to HbA1c-related misdiagnosis or inappropriate management in up to 30 million Americans. Older adults, non-Hispanic Black individuals, and others with high mismatches may benefit from complementing HbA1c with additional diagnostic and management strategies.
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Affiliation(s)
- Lisa R Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA.
| | - Lauren M Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - J Nina Ham
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Emory University School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Brian T Legvold
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Peter W F Wilson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Division of Cardiology, Department of Medicine, School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Atlanta Veterans Affairs Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, USA
| | - Mary K Rhee
- Atlanta Veterans Affairs Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, USA; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Lawrence S Phillips
- Atlanta Veterans Affairs Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, USA; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA
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Lin CH, Lai YC, Chang TJ, Jiang YD, Chang YC, Chuang LM. Hemoglobin glycation index predicts renal function deterioration in patients with type 2 diabetes and a low risk of chronic kidney disease. Diabetes Res Clin Pract 2022; 186:109834. [PMID: 35314255 DOI: 10.1016/j.diabres.2022.109834] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/24/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Abstract
AIMS Hemoglobin glycation index (HGI) is used to describe the difference between estimated and measured glycated hemoglobin (HbA1c). We aimed to study whether HGI can predict renal function deterioration in patients with type 2 diabetes and a low risk of chronic kidney disease (CKD). METHODS This retrospective cohort study enrolled 780 patients with type 2 diabetes and a low CKD risk according to the criteria of kidney disease: improving global outcomes. Participants were divided into two subgroups according to the baseline HGI calculated by fasting blood glucose and HbA1c. Multivariate Cox proportional hazard models were used to evaluate the hazard ratios of the study endpoints. Longitudinal data was analyzed using generalized estimating equation (GEE). RESULTS The participants were followed for a median of 7.3 years. A high HGI predicted rapid renal function decline without or with a resultant eGFR < 60 ml/min/1.73 m2, but not onset of macroalbuminuria. The longitudinal GEE model demonstrated a negative association between HGI and the predicted eGFR changes in both the 1-year and 3-year intervals. CONCLUSIONS HGI independently predicted renal function deterioration in patients with type 2 diabetes and a low CKD risk. Further investigations are warranted to elucidate its potential clinical impact.
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Affiliation(s)
- Chih-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Ying-Chuen Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Tien-Jyun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Yi-Der Jiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Yi-Cheng Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; Graduate Institute of Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 100, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan; Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei 100, Taiwan.
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Tong H, Wang D, Fang M. Correlation between the Variability of Glycosylated Hemoglobin and Cardiovascular Risk in New-Onset T2DM Patients. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5370301. [PMID: 35356363 PMCID: PMC8933119 DOI: 10.1155/2022/5370301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 01/26/2023]
Abstract
Objective To investigate the relationship between glycosylated hemoglobin variant index and cardiovascular disease in patients with type 2 diabetes. Methods A total of 120 patients with type 2 diabetes who were admitted to the Department of Endocrinology in Chun'an Branch of Zhejiang Provincial People's Hospital from January 2014 to January 2017 were enrolled. The clinical data, fasting blood glucose, and glycosylated hemoglobin levels of the patients were collected, and HGI was obtained by calculating the FPG level into the formula. Follow-up for three years was performed to observe the cardiovascular disease (including coronary heart disease and ischemic stroke) in patients. The occurrence of CVD was analyzed in patients with different levels of HGI. Multivariate logistics regression analysis was used to analyze the risk factors of CVD in patients with T2DM. Results After three years of follow-up, 8 cases of 120 patients were lost to follow-up. In the end, 24 cases of CVD occurred in 112 patients, with an incidence rate of 21.43%. Comparing the clinical data of CVD patients and non-CVD patients, it was found that the proportion of age, FPG, HbA1c, HGI, and insulin control in the CVD group was higher than that of the non-CVD group, and the difference was statistically significant (P < 0.05). After grouping according to different HGI levels, it was found that with the increase of HGI level, the proportion of HbA1c, FPG, TC, CVD, and insulin use showed an upward trend (P < 0.05). Multivariate logistic regression analysis showed that high HGI level (OR = 4.660), older age (OR = 4.815), and higher FPG level (OR = 1.717) are independent risk factors that affect T2DM patients with cardiovascular disease (P < 0.05). Conclusion High HGI is independently associated with CVD events in patients with type 2 diabetes. HGI testing is helpful for clinical assessment of personalized assessment and prediction of cardiovascular risk in patients with diabetes.
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Affiliation(s)
- HuoMu Tong
- Department of Endocrinology, Chun'an Branch of Zhejiang Provincial People's Hospital, Hangzhou 311700, China
| | - DongYing Wang
- Department of Endocrinology, Chun'an Branch of Zhejiang Provincial People's Hospital, Hangzhou 311700, China
| | - MiaoZhen Fang
- Department of Endocrinology, Chun'an Branch of Zhejiang Provincial People's Hospital, Hangzhou 311700, China
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Wang Z, Liu Y, Xie J, Liu NF. Association between hemoglobin glycation index and subclinical myocardial injury in the general population free from cardiovascular disease. Nutr Metab Cardiovasc Dis 2022; 32:469-478. [PMID: 34895803 DOI: 10.1016/j.numecd.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 10/09/2021] [Accepted: 10/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS The relationship between hemoglobin glycation index (HGI) and the diagnosis and prognosis of cardiovascular disease (CVD) has been verified by previous studies. However, it remains unknown whether HGI has a predictive effect on subclinical myocardial injury (SC-MI). The purpose of the present study was to explore the relationship between HGI and SC-MI in the general population free from CVD. METHODS AND RESULTS The present study included 6009 participants free of CVD from the third National Health and Nutrition Examination Survey. Binary Logistic regression analysis was used to tested the association between HGI and SC-MI. As results, the HGI was significantly higher in participants with SC-MI compared with those without, and the HGI was positively correlated with SC-MI and other metabolic disorder parameters. Each 1-unit increase of HGI and glycated hemoglobin A1c (HbA1c) was independently associated with higher risk of SC-MI (P < 0.05), while fasting plasma glucose (FPG) was no longer a predictive indicator of SC-MI with the increase of confounding factors [OR (95% CI): 1.001 (0.999-1.003), P = 0.305]. And in the subgroup analysis, HGI, only in participants without diabetes, was independently associated with higher risk of SC-MI, while HbA1c and FPG had no independent predictive role in both diabetic and non-diabetic participants. CONCLUSIONS HGI was a significant predictor of SC-MI in the general population free from CVD.
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Affiliation(s)
- Zhenwei Wang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Yihai Liu
- Department of Cardiology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jing Xie
- College of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210000, China
| | - Nai-Feng Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China.
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22
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Lyu L, Yu J, Liu Y, He S, Zhao Y, Qi M, Ping F, Xu L, Li W, Zhang H, Li Y. High Hemoglobin Glycation Index Is Associated With Telomere Attrition Independent of HbA1c, Mediated by TNFα. J Clin Endocrinol Metab 2022; 107:462-473. [PMID: 34562085 DOI: 10.1210/clinem/dgab703] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The hemoglobin glycation index (HGI) is correlated with metabolic diseases and inflammation. Whether the HGI is associated with the aging process and how inflammation and oxidative stress affect the relationship remain unclear. OBJECTIVE We aimed to analyze links between the HGI and aging biomarkers, and to explore a potential role of inflammation and oxidative stress in the correlations. METHODS A cross-sectional study of 434 subjects with different glucose intolerances in a rural community was enrolled. The HGI was calculated as the difference between the measured and predicted hemoglobin A1c (HbA1c). The population was categorized into tertiles of the HGI. Telomere length (LTL) and mitochondrial DNA copy number (mtDNAcn) determined by polymerase chain reaction assay. Tumor necrosis factor (TNF) α and interleukin (IL) 6, 8-oxo-2'-deoxyguanosine (8-oxo-dG), superoxide dismutase (SOD) activities, and glutathione reductase (GR) were measured. RESULTS Participants in the high HGI group were older and reported a shorter LTL, higher levels of TNFα, SOD activities, and HbA1c. Correlation analyses demonstrated that HGI was correlated with LTL (r = -0.25, P < .001) and TNFα (r = 0.19, P < .001) regardless of HbA1c levels. No relationship was found between HGI and mtDNAcn. HGI (β = -0.238, 95% CI -0.430, -0.046, P = .015) and TNFα (β = -0.02, 95% CI -0.030, -0.014, P < .001) were proved to be correlated with LTL independently, using multiple linear regression analysis. Ordinal logistic regression models showed that compared with subjects the high HGI group, the possibilities of a higher-level LTL was 5.29-fold in the low HGI group (OR 5.29, 95% CI (2.45, 11.41), P < .001), 2.41-fold in the moderate HGI group (OR 2.41, 95% CI 1.35, 4.30, P = .003) after controlling for confounding variables. Mediation analyses indicated that TNFα accounted for 30.39% of the effects of the HGI on LTL. CONCLUSION HGI was negatively related to telomere attrition, independent of HbA1c. TNFα acted as a mediator of the relationship between HGI and LTL.
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Affiliation(s)
- Lu Lyu
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jie Yu
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yiwen Liu
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shuli He
- Department of Nutrition, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yuan Zhao
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mengya Qi
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Fan Ping
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Lingling Xu
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei Li
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Huabing Zhang
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yuxiu Li
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Klein KR, Franek E, Marso S, Pieber TR, Pratley RE, Gowda A, Kvist K, Buse JB. Hemoglobin glycation index, calculated from a single fasting glucose value, as a prediction tool for severe hypoglycemia and major adverse cardiovascular events in DEVOTE. BMJ Open Diabetes Res Care 2021; 9:e002339. [PMID: 34819298 PMCID: PMC8614152 DOI: 10.1136/bmjdrc-2021-002339] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/31/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hemoglobin glycation index (HGI) is the difference between observed and predicted glycated hemoglobin A1c (HbA1c), derived from mean or fasting plasma glucose (FPG). In this secondary, exploratory analysis of data from DEVOTE, we examined: whether insulin initiation/titration affected the HGI; the relationship between baseline HGI tertile and cardiovascular and hypoglycemia risk; and the relative strengths of HGI and HbA1c in predicting these risks. RESEARCH DESIGN AND METHODS In DEVOTE, a randomized, double-blind, cardiovascular outcomes trial, people with type 2 diabetes received once per day insulin degludec or insulin glargine 100 units/mL. The primary outcome was time to first occurrence of a major adverse cardiovascular event (MACE), comprising cardiovascular death, myocardial infarction or stroke; severe hypoglycemia was a secondary outcome. In these analyses, predicted HbA1c was calculated using a linear regression equation based on DEVOTE data (HbA1c=0.01313 FPG (mg/dL) (single value)+6.17514), and the population data were grouped into HGI tertiles based on the calculated HGI values. The distributions of time to first event were compared using Kaplan-Meier curves; HRs and 95% CIs were determined by Cox regression models comparing risk of MACE and severe hypoglycemia between tertiles. RESULTS Changes in HGI were observed at 12 months after insulin initiation and stabilized by 24 months for the whole cohort and insulin-naive patients. There were significant differences in MACE risk between baseline HGI tertiles; participants with high HGI were at highest risk (low vs high, HR: 0.73 (0.61 to 0.87)95% CI; moderate vs high, HR: 0.67 (0.56 to 0.81)95% CI; p<0.0001). No significant differences between HGI tertiles were observed in the risk of severe hypoglycemia (p=0.0911). With HbA1c included within the model, HGI no longer significantly predicted MACE. CONCLUSIONS High HGI was associated with a higher risk of MACE; this finding is of uncertain significance given the association of HGI with insulin initiation and HbA1c. TRIAL REGISTRATION NUMBER NCT01959529.
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Affiliation(s)
- Klara R Klein
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Edward Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Central Clinical Hospital MSW, Warsaw, Poland
| | - Steven Marso
- HCA Midwest Health Heart and Vascular Institute, Overland Park, Kansas, USA
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Richard E Pratley
- AdventHealth Translational Research Institute, Orlando, Florida, USA
| | | | | | - John B Buse
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Lin L, Wang A, He Y, Wang W, Gao Z, Tang X, Yan L, Wan Q, Luo Z, Qin G, Chen L, Mu Y, Dou J. Effects of the hemoglobin glycation index on hyperglycemia diagnosis: Results from the REACTION study. Diabetes Res Clin Pract 2021; 180:109039. [PMID: 34481909 DOI: 10.1016/j.diabres.2021.109039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
AIMS This study aimed to assess the effects of the hemoglobin glycation index (HGI) on hyperglycemia diagnosis and summarize the general characteristics of patients with a high-HGI phenotype. METHODS The fasting plasma glucose and glycated hemoglobin (HbA1c) levels of participants (n = 47,648) were used to estimate a linear regression equation and determine the baseline HGI. Overall, 42,317 participants without a history of diabetes were included in the final analysis. The participants were divided into three groups according to the tertiles (low, moderate, and high) of baseline HGI. Proportions and variables were compared among the three HGI groups. A multivariate ordered logistic regression model was used to explore associations between related variables and the high-HGI phenotype. RESULTS Regression analysis indicated that the high-HGI phenotype was positively associated with female sex, advanced age, obesity, increased low-density lipoprotein and triglyceride levels, decreased high-density lipoprotein cholesterol, and postprandial glycemic excursion levels (all P < 0.05). The prevalence of hyperglycemia increased from the low- to the high-HGI groups when using HbA1c for diagnosis. CONCLUSIONS Individuals with high HGI have similar clinical characteristics. Measuring HbA1c alone for diagnosis could lead to inappropriate diabetes management decisions in people with low or high HGI.
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Affiliation(s)
- Lu Lin
- Medical School of Chinese PLA, Beijing 100853, China; Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Anping Wang
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China; Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Weiqing Wang
- National Clinical Research Center for Metabolic Diseases, State Key Laboratory of Medical Genomics, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Zhengnan Gao
- Dalian Central Hospital, Dalian 116083, Liaoning, China
| | - Xulei Tang
- First Hospital of Lanzhou University, Lanzhou 730099, Gansu, China
| | - Li Yan
- Zhongshan University Sun Yat-sen Memorial Hospital, Guangzhou 510120, Guangdong, China
| | - Qin Wan
- Southwest Medical University Affiliated Hospital, Luzhou 646099, Sichuan, China
| | - Zuojie Luo
- First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Guijun Qin
- First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Lulu Chen
- Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
| | - Yiming Mu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jingtao Dou
- Medical School of Chinese PLA, Beijing 100853, China; Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
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Hempe JM, Yang S, Liu S, Hsia DS. Standardizing the haemoglobin glycation index. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00299. [PMID: 34558807 PMCID: PMC8502217 DOI: 10.1002/edm2.299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 02/02/2023]
Abstract
Aims A high haemoglobin glycation index (HGI) is associated with greater risk for hypoglycaemia and chronic vascular disease. Standardizing how the HGI is calculated would normalize results between research studies and hospital laboratories and facilitate the clinical use of HGI for assessing risk. Methods The HGI is the difference between an observed HbA1c and a predicted HbA1c obtained by inserting fasting plasma glucose (FPG) into a regression equation describing the linear relationship between FPG and HbA1c in a reference population. We used data from the 2005–2016 U.S. National Health and Nutrition Examination Survey (NHANES) to identify a reference population of 18,675 diabetes treatment–naïve adults without self‐reported diabetes. The reference population regression equation (predicted HbA1c = 0.024 FPG + 3.1) was then used to calculate the HGI and divide participants into low (<−0.150), moderate (−0.150 to <0.150) and high (≥0.150) HGI subgroups. Diabetes status was classified by OGTTs. Results As previously reported in multiple studies, a high HGI was associated with black race independent of diabetes status, and with older age, higher BMI and higher CRP in normal and prediabetic but not diabetic participants. The mean HGI was 0.6% higher in self‐reported diabetic adults. The HGI was not associated with plasma insulin, HOMA‐IR or 2 h OGTT in participants classified as normal, prediabetic or diabetic. Conclusions The regression equation derived from this demographically diverse diabetes treatment–naïve adult NHANES reference population is suitable for standardizing how the HGI is calculated for both clinical use and in research to mechanistically explain population variation in the HGI and why a high HGI is associated with greater risk for chronic vascular disease.
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Affiliation(s)
- James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Shengping Yang
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Shuqian Liu
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Wu JD, Liang DL, Xie Y, Chen MY, Chen HH, Sun D, Hu HQ. Association Between Hemoglobin Glycation Index and Risk of Cardiovascular Disease and All Cause Mortality in Type 2 Diabetic Patients: A Meta-Analysis. Front Cardiovasc Med 2021; 8:690689. [PMID: 34124211 PMCID: PMC8193090 DOI: 10.3389/fcvm.2021.690689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The hemoglobin glycation index (HGI) has been proposed as a marker to quantify inter-individual variation in hemoglobin glycosylation. However, whether HGI is associated with an increased risk of diabetic complications independent of glycated hemoglobin (HbA1c) remains unclear. This meta-analysis aimed to determine the association between HGI and the risk of all cause mortality and composite cardiovascular disease (CVD). Methods: PubMed, and EMBASE databases were searched for related studies up to March 31, 2021. Observational studies reported associations between HGI levels and composite CVD and all cause mortality were included for meta-analysis. A random effect model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CI) for higher HGI. Results: A total of five studies, comprising 22,035 patients with type two diabetes mellitus were included for analysis. The median follow-up duration was 5.0 years. After adjusted for multiple conventional cardiovascular risk factors, an increased level of HGI was associated with a higher risk of composite CVD (per 1 SD increment: HR = 1.14, 95% CI = 1.04–1.26) and all cause mortality (per 1 SD increment: HR = 1.18, 95% CI = 1.05–1.32). However, when further adjusted for HbA1c, the association between HGI and risk of composite CVD (per 1 SD increment of HGI: HR = 1.01, 95% CI = 0.93–1.10) and all cause mortality (per 1 SD increment of HGI: HR = 1.03, 95% CI = 0.96–1.10) became insignificant. Conclusions: High HGI was associated with an increased risk of composite CVD and all cause mortality after adjustment for multiple conventional cardiovascular risk factors. However, the association was mainly mediating by the level of HbA1c.
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Affiliation(s)
- Jian-di Wu
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Dong-Liang Liang
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Yue Xie
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Mei-Yu Chen
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Hai-Hong Chen
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Dan Sun
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Hui-Qi Hu
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
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Nguyen JV, Roseberry S, Rivas JA, Cauthon KAB. Hypoglycemia in Older People With Type 2 Diabetes: Prevention and Treatment Strategies for Outpatient and Long-Term Care Facility Settings. Sr Care Pharm 2021; 36:112-123. [PMID: 33509335 DOI: 10.4140/tcp.n.2021.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hypoglycemia in the older population is a significant problem accounting for increased hospitalizations, emergency room visits, health care costs, and decreased quality of life. Older patients are more susceptible to hypoglycemia because of the increased prevalence of comorbidities requiring multiple medications, age-related physiologic changes, and a progressive decline in health. Older patients are less likely to present with symptoms of hypoglycemia and symptoms may frequently appear at a lower threshold of blood glucose than in younger patients. Consequently, preventing and treating hyperglycemia in older patients can be challenging. If mismanaged, the impact of hypoglycemia in these patients can lead to acute and chronic negative outcomes. Insulin and sulfonylureas should be closely monitored, and deprescribing should be routinely considered in older patients at high risk for hypoglycemia.
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Kim W, Go T, Kang DR, Lee EJ, Huh JH. Hemoglobin glycation index is associated with incident chronic kidney disease in subjects with impaired glucose metabolism: A 10-year longitudinal cohort study. J Diabetes Complications 2021; 35:107760. [PMID: 33077349 DOI: 10.1016/j.jdiacomp.2020.107760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
AIM We investigated the associations between hemoglobin glycation index (HGI) and incident chronic kidney disease (CKD) in treatment-naïve subjects with prediabetes or diabetes. METHODS We conducted a prospective cohort study comprising 2187 subjects with prediabetes or diabetes. HGI was calculated as the difference between the measured and predicted values of HbA1c using the linear relationship between HbA1c level and fasting plasma glucose levels. Incident CKD was considered if eGFR decreased to <60 mL/min/1.73 m2 and by >25% from the baseline value during follow up. The hazard ratios (HRs) for incident CKD were calculated using Cox proportional hazards regression models. RESULTS The overall prevalence of CKD was 15.3% (n = 335) during the 10-year follow-up period. The prevalence of CKD increased significantly from the low to the high HGI groups. In the multivariate analysis, the highest HGI group showed the highest adjusted HR for incident CKD (HR, 1.57; 95% confidence interval, 1.06-2.34), and this remained significant even after adjusting for the HbA1c level. CONCLUSIONS High HGI was associated with an increased risk of incident CKD among treatment-naïve subjects with prediabetes or diabetes, suggesting that HGI may be used to predict CKD in these patients regardless of HbA1c levels.
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Affiliation(s)
- Wonjin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam CHA Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea; Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
| | - Taehwa Go
- Center of Biomedical Data Science, Yonsei University, Wonju College of Medicine, Wonju 26426, Republic of Korea.
| | - Dae Ryong Kang
- Center of Biomedical Data Science, Yonsei University, Wonju College of Medicine, Wonju 26426, Republic of Korea.
| | - Eun Jig Lee
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
| | - Ji Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea; Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju 26426, Republic of Korea.
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Li Z, Wang F, Jia Y, Guo F, Chen S. The Relationship Between Hemoglobin Glycation Variation Index and Vitamin D in Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2021; 14:1937-1948. [PMID: 33958883 PMCID: PMC8096423 DOI: 10.2147/dmso.s310672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between hemoglobin glycation variation index (HGI) and vitamin D in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This is a cross-sectional study that recruited 347 patients with T2DM. The subjects were divided into no vitamin D deficiency group (25(OH)D ≥20 ng/mL) and vitamin D deficiency group (25(OH)D < 20 ng/mL). HGI was calculated as the difference between the measured and predicted values of HbA1c using the linear relationship between HbA1c level and fasting plasma glucose levels. All study participants were divided into high HGI and low HGI groups using the median of HGI as the boundary. At last, the subjects were divided into male group and female group, and these groups were further subdivided into vitamin D deficiency group and no vitamin D deficiency group. RESULTS The levels of HGI were significantly higher in the vitamin D deficiency group compared with the no vitamin D deficiency group for all patients. The same was true for female patients but not for male patients. The prevalence of vitamin D deficiency in the high HGI group was higher than that in the low HGI group. The high HGI group had lower vitamin D levels compared to the low HGI group. Compared to the male group, the female group had lower vitamin D levels but higher HGI levels. A negative correlation existed between 25(OH) D and HGI in all subjects, as well as in the female-only subgroups. In the male-only subgroups, there was no correlation between them, and this positive correlation still existed after adjusting for other factors in multilinear regression analysis. CONCLUSION Our study showed for the first time that HGI is inversely associated with vitamin D in all patients with T2DM, and the correlation was also found in female patients, but not in male patients.
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Affiliation(s)
- Zelin Li
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Fei Wang
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Yujiao Jia
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Feiyue Guo
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Glandular Surgery, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Shuchun Chen
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
- Hebei Key Laboratory of Metabolic Diseases, Hebei, People's Republic of China
- Correspondence: Shuchun Chen Department of Endocrinology, Hebei General Hospital, 348 Heping West Road, Shijiazhuang, Hebei, 050051, People’s Republic of ChinaTel +86 31185988406Fax +86 31185988406 Email
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Li Z, Gao Y, Jia Y, Chen S. Correlation Between Hemoglobin Glycosylation Index and Nerve Conduction Velocity in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2021; 14:4757-4765. [PMID: 34887673 PMCID: PMC8653709 DOI: 10.2147/dmso.s334767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/13/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between hemoglobin glycation variation index (HGI) and peripheral nerve conduction velocity (NCV) in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This is a cross-sectional study, including 324 patients with T2DM were included in this study. Basic information and blood indicators were collected. The motor conduction velocities (MCV) of the bilateral ulnar nerve, median nerve, and common peroneal nerve, and the sensory conduction velocities (SCV) of the ulnar nerve, median nerve, and superficial peroneal nerve were measured. The patients were divided into two groups according to the NCV: normal nerve conduction group (NCVN group) and abnormal nerve conduction group (NCVA group). When the NCV is less than the specific normal value, the patients were divided into the NCVA group. HGI was calculated as the difference between the measured and predicted values of glycosylated hemoglobin (HbA1c) using the linear relationship between HbA1c level and fasting plasma glucose levels. At last, all study participants were divided into High HGI and Low HGI groups using the median of HGI as the boundary. The study also analyzed the correlation between HGI and NCV. RESULTS Compared to the NCVN group, the HGI levels of the NCVA group were higher (P < 0.001). The prevalence of NCVA in the high HGI group was higher than that in the low HGI group (P = 0.004). HGI was negatively correlated with bilateral ulnar nerve MCV, bilateral median nerve MCV, bilateral common peroneal nerve MCV, bilateral median nerve SCV and left superficial peroneal nerve SCV, and the correlation still existed after adjusting for confounding factors. CONCLUSION This study found that HGI is inversely associated with NCV in patients with T2DM, and this correlation is higher between HGI and MCV of peripheral nerve.
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Affiliation(s)
- Zelin Li
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Yuan Gao
- Shijiazhuang 16th Retired Cadre Rest Center of Hebei Military Region, Shijiazhuang, Hebei, People’s Republic of China
| | - Yujiao Jia
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Shuchun Chen
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
- Hebei Key Laboratory of Metabolic Diseases, Shijiazhuang, Hebei, People’s Republic of China
- Correspondence: Shuchun Chen Department of Endocrinology, Hebei General Hospital, 348 Heping West Road, Shijiazhuang, Hebei, 050051, People’s Republic of ChinaTel/Fax +86 311 85988406 Email
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Klein KR, Buse JB. The trials and tribulations of determining HbA 1c targets for diabetes mellitus. Nat Rev Endocrinol 2020; 16:717-730. [PMID: 33082551 DOI: 10.1038/s41574-020-00425-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 12/19/2022]
Abstract
Glycated haemoglobin (HbA1c) is considered the gold standard for predicting glycaemia-associated risks for the microvascular and macrovascular complications of diabetes mellitus over 5-10 years. The value of HbA1c in the care of patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) is unassailable, yet HbA1c targets remain contentious. Guidelines from diabetes care organizations recommend conflicting HbA1c targets - generally between 6.5% and 8%. However, all such organizations advocate for individualization of HbA1c targets, leaving both health-care providers and their patients confused about what HbA1c target is appropriate in an individual patient. In this Review, we outline the landmark T1DM and T2DM trials that informed the current guidelines, we discuss the evidence that drives individualized HbA1c targets, we examine the limitations of HbA1c, and we consider alternatives for monitoring glycaemic control. Ultimately, in synthesizing this literature, we argue for an HbA1c target of <7% for most individuals, but emphasize the importance of helping patients determine their own personal goals and determinants of quality of life that are independent of a particular glycaemic target. We also recognize that as newer technologies and anti-hyperglycaemic therapies emerge, glycaemic targets will continue to evolve.
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Affiliation(s)
- Klara R Klein
- Division of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - John B Buse
- Division of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Mi J, Song J, Zhao Y, Wu X. Association of hemoglobin glycation index and its interaction with obesity/family history of hypertension on hypertension risk: a community-based cross-sectional survey. BMC Cardiovasc Disord 2020; 20:477. [PMID: 33148181 PMCID: PMC7640660 DOI: 10.1186/s12872-020-01762-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/29/2020] [Indexed: 01/12/2023] Open
Abstract
Background Hemoglobin glycation index (HGI) is considered to be a convenient measurable indicator to assess the inter-individual variation of HbA1c. In the present study, we tested the relationship between HGI and risk of hypertension, and further explored the possible interacting influences of HGI with other such factors on hypertension risk among Chinese individuals. Methods The eligible subjects were chosen from a community-based cross-sectional survey in China. We collected relevant data and clinical indicators for each participant. HGI was calculated as “measured HbA1c-predicted HbA1c” and divided into four categories according to quartile. The following indicators were used to assess interactive effects: (1) relative excess risk due to interaction (RERI); (2) attributable proportion due to interaction (AP); and (3) synergy index (SI). Statistical analysis was performed using R software. Results Specifically, 1777 eligible participants were selected in this cross-sectional survey. There were 433 subjects who were identified to have hypertension (24.4%). A significant increase in the prevalence of hypertension from Q1 to Q4 of HGI was observed (p < 0.001). Multivariable logistic model demonstrated that subjects at the highest HGI group had a substantially increased risk of being hypertensive than subjects in the first quartile of HGI, as indicated by the OR value of 1.87 (95% CI 1.26–2.78). Moreover, a significant interaction between family history of hypertension and HGI on hypertension risk was detected (RERI: 1.36, 95% CI 0.11–2.63; AP: 0.43, 95% CI 0.17–0.69; and SI:2.68, 95% CI 1.10–6.48). The interactive effect between HGI and abdominal obesity was also found to be significant, as estimated by the value of RERI (1.04, 95% CI 0.24–1.85), AP (0.33, 95% CI 0.11–0.56) and SI (1.96, 95% CI 1.01–3.79). However, in the analysis of the interaction between HGI and general obesity, only the AP value (0.28, 95% CI 0.01–0.54) was observed to be significant. Conclusion High HGI was independently associated with the risk of hypertension. Moreover, HGI significantly shared interactions with obesity and family history of hypertension that influenced the risk of hypertension.
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Affiliation(s)
- Jing Mi
- School of Public Health, Bengbu Medical College, 2600 Donghai road, Bengbu, 233000, Anhui Province, China
| | - Jian Song
- School of Public Health, Bengbu Medical College, 2600 Donghai road, Bengbu, 233000, Anhui Province, China
| | - Yingying Zhao
- Bengbu Health Board, 568 Nanhu road, Bengbu, 233000, Anhui Province, China
| | - Xuesen Wu
- School of Public Health, Bengbu Medical College, 2600 Donghai road, Bengbu, 233000, Anhui Province, China.
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Zhang L, Wang M, Zhang R, Zhong Y, Fan H, Wang M, Wang J. Hemoglobin glycation index in relationship to the risk of cardiovascular complication in patients with type 2 diabetes: A systematic review and meta-analysis. J Diabetes Complications 2020; 34:107673. [PMID: 32768332 DOI: 10.1016/j.jdiacomp.2020.107673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/27/2020] [Accepted: 07/05/2020] [Indexed: 01/08/2023]
Abstract
AIM To estimate the association of hemoglobin glycation index (HGI) level with total mortality and cardiovascular complication risk among patients with T2DM. METHODS Literatures evaluating the associations of HGI with the risk of cardiovascular outcomes and total mortality in patients with T2DM were systematically searched by using the PubMed and Embase databases from January 2002 to April 2019. Fixed-effects model and random-effects model meta-analyses were used to calculate pooled adjusted hazard ratios (HRs). RESULTS Six prospective cohort studies and one nest case-control study (comprising n = 37,280) were included in this systematic review. T2DM patients with high HGI level had significant high HRs (95% confidence interval, 95% CI) for cardiovascular complication [1.25 (1.16, 1.36)] and total mortality [1.26 (1.14, 1.39)] compared to intermediate HGI level. For every 1-unit increment in HGI, the average HR (95% CI) were 1.20 (1.00, 1.41) for cardiovascular complication and 1.13 (1.06, 1.19) for total mortality. CONCLUSIONS The findings suggested that a rising HGI level was associated with the increased risk for cardiovascular complication and total mortality among patients with T2DM.
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Affiliation(s)
- Liuxin Zhang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing 211166, Jiangsu, China
| | - Minxian Wang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing 211166, Jiangsu, China
| | - Ru Zhang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing 211166, Jiangsu, China
| | - Yuling Zhong
- Dermatology Hospital of Southern Medical University, No. 2 LuJing Road, YueXiu District, Guangzhou 510091, China
| | - Haozhi Fan
- The first Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing 210029, Jiangsu, China
| | - Min Wang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing 211166, Jiangsu, China
| | - Jie Wang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing 211166, Jiangsu, China.
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Chalmers J, Woodward M. Observational analyses from ADVANCE and ADVANCE-ON. Diabetes Obes Metab 2020; 22 Suppl 2:19-32. [PMID: 31729126 DOI: 10.1111/dom.13894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023]
Abstract
AIMS To explain, and document, the epidemiological work associated with the action in diabetes and vascular disease: preterax and diamicron-modified release controlled evaluation (ADVANCE) clinical trial. MATERIALS AND METHODS ADVANCE was designed as a randomized controlled multicentre factorial trial in high-risk patients with diabetes. The two interventions were blood pressure lowering medications versus placebo, and intensive glucose control versus standard glucose control. Following termination of the trial, an observational study of surviving participants, able to join, was mounted: the ADVANCE - observational study (ADVANCE-ON). Other epidemiological analyses that were undertaken treated the trial as a cohort study, including using biomarkers from the blood samples taken from ADVANCE subjects as risk exposures. RESULTS More than 50 publications have reported epidemiological results from ADVANCE. The main results from ADVANCE-ON suggested attenuated benefits of ADVANCE's blood pressure lowering treatment on all-cause and cardiovascular death, but no such long-term benefits for intensive glucose control, although this did give persistent benefit for end-stage renal disease. The other epidemiological studies found, amongst other things, strong effects of NT-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin T on macrovascular events, microvascular events and all-cause death. CONCLUSIONS Embedding post-randomization and epidemiological analyses into clinical trials is worthwhile and can be highly productive in advancing scientific knowledge.
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Affiliation(s)
- John Chalmers
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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Hsia DS, Rasouli N, Pittas AG, Lary CW, Peters A, Lewis MR, Kashyap SR, Johnson KC, LeBlanc ES, Phillips LS, Hempe JM, Desouza CV. Implications of the Hemoglobin Glycation Index on the Diagnosis of Prediabetes and Diabetes. J Clin Endocrinol Metab 2020; 105:5713508. [PMID: 31965161 PMCID: PMC7015453 DOI: 10.1210/clinem/dgaa029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG) from a 75-g oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) can lead to different results when diagnosing prediabetes and diabetes. The Hemoglobin Glycation Index (HGI) quantifies the interindividual variation in glycation resulting in discrepancies between FPG and HbA1c. We used data from the Vitamin D and Type 2 Diabetes (D2d) study to calculate HGI, to identify HGI-associated variables, and to determine how HGI affects prediabetes and diabetes diagnosis. MEASUREMENTS A linear regression equation [HbA1c (%) = 0.0164 × FPG (mg/dL) + 4.2] was derived using the screening cohort (n = 6829) and applied to calculate predicted HbA1c. This was subtracted from the observed HbA1c to determine HGI in the baseline cohort with 2hPG data (n = 3945). Baseline variables plus prediabetes and diabetes diagnosis by FPG, HbA1c, and 2hPG were compared among low, moderate, and high HGI subgroups. RESULTS The proportion of women and Black/African American individuals increased from low to high HGI subgroups. Mean FPG decreased and mean HbA1c increased from low to high HGI subgroups, consistent with the HGI calculation; however, mean 2hPG was not significantly different among HGI subgroups. CONCLUSIONS High HGI was associated with Black race and female sex as reported previously. The observation that 2hPG was not different across HGI subgroups suggests that variation in postprandial glucose is not a significant source of population variation in HGI. Exclusive use of HbA1c for diagnosis will classify more Black individuals and women as having prediabetes compared with using FPG or 2hPG.
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Affiliation(s)
- Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Neda Rasouli
- University of Colorado, School of Medicine and VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Anastassios G Pittas
- Tufts Medical Center, Boston, Massachusetts
- Correspondence and Reprint Requests: Anastassios Pittas, MD, Tufts Medical Center, 800 Washington Street, Box #268, Boston, Massachusetts 02111.
| | - Christine W Lary
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine
| | - Anne Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Michael R Lewis
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont
| | | | - Karen C Johnson
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research NW, Portland, Oregon
| | - Lawrence S Phillips
- Atlanta VA Medical Center, Decatur, Georgia and Emory University School of Medicine, Atlanta, Georgia
| | - James M Hempe
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Cyrus V Desouza
- Omaha VA Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
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Czobor NR, Lehot JJ, Holndonner-Kirst E, Tully PJ, Gal J, Szekely A. Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence. Ther Clin Risk Manag 2019; 15:1217-1232. [PMID: 31802876 PMCID: PMC6802734 DOI: 10.2147/tcrm.s217717] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/01/2019] [Indexed: 12/13/2022] Open
Abstract
Frailty is presumably associated with an elevated risk of postoperative mortality and adverse outcome in vascular surgery patients. The aim of our review was to identify possible methods for risk assessment and prehabilitation in order to improve recovery and postoperative outcome. The literature search was performed via PubMed, Embase, OvidSP, and the Cochrane Library. We collected papers published in peer-reviewed journals between 2001 and 2018. The selection criterion was the relationship between vascular surgery, frailty and postoperative outcome or mortality. A total number of 52 publications were included. Frailty increases the risk of non-home discharge independently of presence or absence of postoperative complications and it is related to a higher 30-day mortality and major morbidity. The modified Frailty Index showed significant association with elevated risk for post-interventional stroke, myocardial infarction, prolonged in-hospital stays and higher readmission rates. When adjusted for comorbidity and surgery type, frailty seems to impact medium-term survival (within 2 years). Preoperative physical exercising, avoidance of hypalbuminemia, psychological and cognitive training, maintenance of muscle strength, adequate perioperative nutrition, and management of smoking behaviours are leading to a reduced length of stay and a decreased incidence of readmission rate, thus improving the effectiveness of early rehabilitation. Pre-frailty is a dynamically changing state of the patient, capable of deteriorating or improving over time. With goal-directed preoperative interventions, the decline can be prevented.
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Affiliation(s)
- Nikoletta Rahel Czobor
- Medical Centre of Hungarian Defense Forces, Department of Anesthesiology and Intensive Care, Budapest, Hungary.,Semmelweis University, School of Doctoral Studies, Budapest, Hungary
| | - Jean-Jacques Lehot
- Claude-Bernard University, Health Services and Performance Research Lab (EA 7425 HESPER), Lyon, France.,Hôpital Neurologique Pierre Wertheimer, Department of Neuroanesthesia and Intensive Care, Hospices Civils de Lyon, Lyon, France
| | - Eniko Holndonner-Kirst
- Medical Centre of Hungarian Defense Forces, Department of Anesthesiology and Intensive Care, Budapest, Hungary
| | - Phillip J Tully
- University of Adelaide, Freemasons Foundation Centre for Men's Health, Adelaide, Australia
| | - Janos Gal
- Semmelweis University, Department of Anesthesiology and Intensive Care, Budapest, Hungary
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Care, Budapest, Hungary.,Semmelweis University, Heart and Vascular Center of Városmajor, Budapest, Hungary
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Nayak AU, Singh BM, Dunmore SJ. Potential Clinical Error Arising From Use of HbA1c in Diabetes: Effects of the Glycation Gap. Endocr Rev 2019; 40:988-999. [PMID: 31074800 DOI: 10.1210/er.2018-00284] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/05/2019] [Indexed: 01/17/2023]
Abstract
The glycation gap (GGap) and the similar hemoglobin glycation index (HGI) define consistent differences between glycated hemoglobin and actual glycemia derived from fructosamine or mean blood glucose, respectively. Such a disparity may be found in a substantial proportion of people with diabetes, being >1 U of glycated HbA1c% or 7.2 mmol/mol in almost 40% of estimations. In this review we define these indices and explain how they can be calculated and that they are not spurious, being consistent in individuals over time. We evaluate the evidence that GGap and HGI are associated with variation in risk of complications and mortality and demonstrate the potential for clinical error in the unquestioning use of HbA1c. We explore the underlying etiology of the variation of HbA1c from mean glucose in blood plasma, including the potential role of enzymatic deglycation of hemoglobin by fructosamine-3-kinase. We conclude that measurement of GGap and HGI are important to diabetes clinicians and their patients in individualization of therapy and the avoidance of harm arising from consequent inappropriate assessment of glycemia and use of therapies.
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Affiliation(s)
- Ananth U Nayak
- Department of Endocrinology and Diabetes, University Hospital of North Midlands NHS Trust, Stoke on Trent, United Kingdom
| | - Baldev M Singh
- Diabetes Research Group, School of Medicine and Clinical Practice, University of Wolverhampton, Wolverhampton, United Kingdom.,Wolverhampton Diabetes Centre, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Simon J Dunmore
- Diabetes Research Group, School of Medicine and Clinical Practice, University of Wolverhampton, Wolverhampton, United Kingdom
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Jin JL, Sun D, Cao YX, Guo YL, Wu NQ, Zhu CG, Gao Y, Dong QT, Zhang HW, Liu G, Dong Q, Li JJ. Triglyceride glucose and haemoglobin glycation index for predicting outcomes in diabetes patients with new-onset, stable coronary artery disease: a nested case-control study. Ann Med 2018; 50:576-586. [PMID: 30207490 DOI: 10.1080/07853890.2018.1523549] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Previous studies have shown that both triglyceride glucose (TyG) and haemoglobin glycation indexes (HGI) are predictors of cardiovascular risk. However, the prognostic value of TyG index and HGI in patients with type 2 diabetes mellitus (T2DM) and stable coronary artery disease (CAD) is not determined. METHODS We conducted a nested case-control study among 1282 T2DM patients with stable CAD. Patients were followed up for 3846 person-years. A total of 160 patients with events (12.5%) were identified and matched individually on age, gender, previous use of lipid lowering agents and duration of follow-up with 640 controls. RESULTS In Kaplan-Meier analysis, the upper tertiles of TyG index and HGI had a significant lower event-free survival (p = .002; p = .036, respectively). Of the note, both TyG index and HGI were associated with increased risk of MACCEs after adjusting for confounding risk factors [adjusted HR (95% CI): 1.693 (1.238-2.316); 1.215 (1.046-1.411), respectively]. Moreover, adding TyG index to the Cox model increased the C-statistic to 0.638 (95%CI: 0.595-0.683, p = .002) while the C-statistic was not statistically improved when HGI was included (p = .240). CONCLUSIONS Both TyG index and HGI could predict cardiovascular outcomes in T2DM patients with new-onset, stable CAD while TyG index might be better. Key messages Both TyG and HGI are predictors of cardiovascular risk. The prognostic value of TyG index and HGI in T2DM patients with stable coronary artery disease is not determined. Our study firstly indicates that TyG index might have better prognostic value than HGI in T2DM patients with new-onset, stable CAD.
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Affiliation(s)
- Jing-Lu Jin
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Di Sun
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Ye-Xuan Cao
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Yuan-Lin Guo
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Na-Qiong Wu
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Cheng-Gang Zhu
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Ying Gao
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Qiu-Ting Dong
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Hui-Wen Zhang
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Geng Liu
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Qian Dong
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
| | - Jian-Jun Li
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China
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Kim MK, Jeong JS, Yun JS, Kwon HS, Baek KH, Song KH, Ahn YB, Ko SH. Hemoglobin glycation index predicts cardiovascular disease in people with type 2 diabetes mellitus: A 10-year longitudinal cohort study. J Diabetes Complications 2018; 32:906-910. [PMID: 30121206 DOI: 10.1016/j.jdiacomp.2018.08.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Previous studies have suggested that the hemoglobin glycation index (HGI) can be used as a predictor of diabetes-related complications. We examined the prognostic significance of a high HGI for cardiovascular disease (CVD) in an ongoing hospital-based cohort. METHODS From March 2003 to December 2004, 1302 consecutive patients with type 2 diabetes and without a prior history of CVD were enrolled. CVD was defined as the occurrence of coronary artery disease or ischemic stroke. The HGI was calculated as the measured glycated hemoglobin (HbA1c) minus predicted HbA1c. Predicted HbA1c were calculated for 1302 participants by inserting fasting blood glucose (FBG) into the equation, Predicted HbA1c level = 0.02106 × FBG [mg/dL] + 4.973. Cox proportional hazards models were used to identify the associations between the HGI and CVD after adjusting for confounding variables. RESULTS During 11.1 years of follow-up, 225 participants (17.2%) were newly diagnosed with CVD. The baseline HGI was significantly higher in subjects with incident CVD than in those without CVD, although the baseline FBG levels did not differ according to the occurrence of CVD. Compared with patients without CVD, those with CVD were older, had a longer duration of diabetes and hypertension, and used more insulin at baseline. A Cox hazard regression analysis revealed that the development of CVD was significantly associated with baseline HGI (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.31-2.87; p < 0.001, comparing the highest and lowest quartiles of HGI). This relationship was unchanged after additional adjustment for baseline HbA1c level (HR, 1.74; 95% CI, 1.08-2.81). The HRs of HbA1c in relation to outcomes were similar to or lower than those seen for HGI. After adjustment for HGI, the effect of the highest HbA1c on incident CVD disappeared. CONCLUSIONS High HGI was independently associated with incident CVD in patients with type 2 diabetes. Patients with high HGI at baseline had a higher inherent risk for CVD.
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Affiliation(s)
- Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee Sun Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Wang X, Mao R, Chen W. FSD-C10 Shows Therapeutic Effects in Suppressing oxidized low-density lipoprotein (ox-LDL)-Induced Human Brain Microvascular Endothelial Cells Apoptosis via Rho-Associated Coiled-Coil Kinase (ROCK)/Mitogen-Activated Protein Kinase (MAPK) Signaling. Med Sci Monit 2018; 24:5509-5516. [PMID: 30088495 PMCID: PMC6097139 DOI: 10.12659/msm.911481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND ox-LDL-induced injury of brain microvascular endothelial cells (BMECs) is strongly associated with cerebral vascular diseases such as cerebral arterial atherosclerosis. ROCK inhibitor was proved to be anti-apoptotic and has been used in treating cerebral vascular diseases. Research on the neuroprotective effects of a novel ROCK inhibitor, FSD-C10, is still limited. The present study investigated the anti-apoptotic effect and underlying molecular mechanism of FSD-C10 in ox-LDL-mediated apoptosis of BMECs. MATERIAL AND METHODS ox-LDL and/or FSD-C10 were used to incubate immortalized human BMECs. MTT assay was used to assess cell viability. Cell apoptosis was evaluated by TUNEL assay. A colorimetric method was used to assess ROCK activity. Western blot analysis was used to examine the expression and phosphorylation levels of proteins. RESULTS ox-LDL incubation reduced the viability of BMECs by inducing cell apoptosis in a concentration-dependent manner. ROCK activity was also elevated by ox-LDL incubation in BMECs in a concentration-dependent manner. Expression level of Bcl2 was reduced while expression levels of Bax and active caspase3 were increased by ox-LDL treatment in a concentration-dependent manner. ox-LDL also increased the phosphorylation levels of p38, JNK, and ERK1/2 in a concentration-dependent manner. FSD-C10 treatment increased the cell viability by reducing apoptosis of BMECs exposed to ox-LDL. Moreover, FSD-C10 was found to suppress the phosphorylation levels of p38, JNK, and ERK1/2 and the expression levels of Bax and active caspase3 in ox-LDL treated BMECs. CONCLUSIONS FSD-C10 increases cell viability in ox-LDL-treated BMECs by reducing cell apoptosis. ROCK/MAPKs-mediated apoptosis appears to be the underlying molecular mechanism.
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Affiliation(s)
- Xin Wang
- Department of Neurology, Yiwu Central Hospital, Yiwu, Zhejiang, China (mainland)
| | - Rongyan Mao
- Department of Neurology, Yiwu Central Hospital, Yiwu, Zhejiang, China (mainland)
| | - Weiwei Chen
- Department of Neurology, Yiwu Central Hospital, Yiwu, Zhejiang, China (mainland)
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Limited benefit of haemoglobin glycation index as risk factor for cardiovascular disease in type 2 diabetes patients. DIABETES & METABOLISM 2018; 45:254-260. [PMID: 29784563 DOI: 10.1016/j.diabet.2018.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/05/2018] [Accepted: 04/18/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND The haemoglobin glycation index (HGI) has been proposed as a marker of interindividual differences in haemoglobin glycosylation. Previous studies have shown a relationship between high HGI and risk of cardiovascular disease (CVD) in patients with diabetes. However, no studies have investigated the role of previous CVD in this association. METHODS The study cohort comprised patients with type 2 diabetes mellitus (T2DM; n=1910) included in the Second Manifestations of Arterial Disease (SMART) study. The relationship between either HGI or HbA1c and a composite of cardiovascular events as the primary outcome, and mortality, cardiovascular mortality, myocardial infarction and stroke as secondary outcomes, was investigated using Cox proportional-hazards models. Similar analyses were performed after stratification according to previous CVD. RESULTS A 1-unit higher HGI was associated with a 29% greater risk of a composite of cardiovascular events (HR: 1.29, 95% CI: 1.06-1.57) in patients without previous CVD, whereas no such relationship was seen in patients with previous CVD (HR: 0.96, 95% CI: 0.86-1.08). The direction and magnitude of the hazard ratios (HRs) of HGI and HbA1c in relation to outcomes were similar. Additional adjustment for HbA1c in the association between HGI and outcomes lowered the HRs. CONCLUSION Similar to HbA1c, higher HGI is related to higher risk of cardiovascular events in patients with T2DM without CVD. As HbA1c has proved to be a comparable risk factor, and obtaining and interpreting the HGI is complicated, any additional benefit of applying the HGI in clinical settings is likely to be limited.
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