Israel: Higher variability in blood sugar levels is linked to increased mortality risk in adults with diabetes, a recent study has found.
The study, published in the journal Diabetes/Metabolism Research and Reviews, showed that increasing HbA1c variability and progressive elevation in HbA1c (>7%) were associated with a higher risk of mortality. The data highlight the significance of maintaining glycemic stability and encourages physicians to consider the glycemic burden of their patients while evaluating prognosis.
Avivit Cahn, Hadassah Hebrew University Hospital, Jerusalem, Israel, and colleagues aimed to determine the optimal variables which should be used to define distinct cohorts of HbA1c trends by utilizing machine learning methods.
For this purpose, the researchers collected data on patients with diabetes listed in the Israeli National Diabetes Registry during years 2012–2016 (observation period). Patients with >4 HbA1c measurements, type 1 diabetes, eGFR < 30mg/ml/min, persistent HbA1c < 6% or malignancy were excluded. patients were classified into clusters according to their HbA1c trend (increasing, stable, decreasing) by utilizing machine learning methods.
Mortality risk during 2017–2019 was calculated in subgroups defined by age (35–54, 55–69, 70–89 years) and last HbA1c (≤7% and >7%) at end of the observation period.
This historical cohort study included 293,314 patients.
Key findings of the study include:
Increased HbA1c variability (high SD) during the observation period was an independent predictor of mortality in patients aged more than 55 years.
The HbA1c trend was another independent predictor of mortality.
Patients with a decreasing versus stable HbA1c trend had a greater mortality risk; this association persisted in all age groups in patients with HbA1c > 7% at the end of the observation period (in age 35–54; in aged >55).
Patients with an increasing versus stable HbA1c trend had a greater mortality risk only in the elderly group (>70), yet in both HbA1c categories.
HbA1c variability and trend are important determinants of mortality risk and should be considered when adjusting glycemic targets, concluded the authors.
Reference:
The study titled, "Machine learning based study of longitudinal HbA1c trends and their association with all-cause mortality: Analyses from a National Diabetes Registry," is published in the journal Diabetes/Metabolism Research and Reviews.
DOI: https://onlinelibrary.wiley.com/doi/10.1002/dmrr.3485