PMID- 26663216
OWN - NLM
STAT- MEDLINE
DCOM- 20161014
LR  - 20221207
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 18
IP  - 1
DP  - 2016 Jan
TI  - Mean HbA1c and mortality in diabetic individuals with heart failure: a population 
      cohort study.
PG  - 94-102
LID - 10.1002/ejhf.455 [doi]
AB  - AIMS: Controversy exists regarding the importance of glycaemic control in 
      patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) 
      based on conflicting reports using single baseline glycosyated haemoglobin (HbA1c 
      ). Using the time-weighted mean of serial HbA1c measurements has been found to be 
      a better predictor of diabetic complications as it reflects the glycaemic burden 
      for that individual over time. We therefore sought to confirm this in a large 
      cohort of patients with T2DM and incident CHF. METHODS AND RESULTS: A 
      time-weighted mean HbA1c was calculated using all HbA1c measurements following 
      CHF diagnosis. Patients were grouped into five categories of HbA1c (</=6.0%, 
      6.1-7.0%, 7.1-8.0%, 8.1-9.0%, and >9.0%). The relationship between time-weighted 
      mean HbA1c and all-cause death after CHF diagnosis was assessed. A total of 1447 
      patients with T2DM met the study criteria. During a median follow-up of 
      2.8 years, there were 826 (57.1%) deaths, with a crude death rate of 155 deaths 
      per 1000 person-years [95% confidence interval (CI) 144-166]. A Cox regression 
      model, adjusted for all significant predictors, with the middle HbA1c category 
      (7.1-8.0%) as the reference, showed a U-shaped relationship between HbA1c and 
      outcome [HbA1c <6.0%, hazard ratio (HR) 2.5, 95% CI 1.8-3.4; HbA1c 6.1-7.0%, HR 
      1.4, 95% 1.1-1.7; HbA1c 8.1-9.0%, HR 1.3, 95% CI 1.0-1.6; and HbA1c >9.0%, HR 
      1.8, 95% CI 1.4-2.3]. Further analysis revealed a protective effect of insulin 
      sensitizers (i.e. metformin) (HR 0.7, 95% CI 0.61-0.93) but not other drug 
      classes. CONCLUSIONS: In patients with T2DM and CHF, our study shows a U-shaped 
      relationship between HbA1c and mortality, with the lowest risk in patients with 
      modest glycaemic control (HbA1c 7.1-8.0%) and those treated with insulin 
      sensitizers.
CI  - (c) 2015 The Authors. European Journal of Heart Failure published by John Wiley & 
      Sons Ltd on behalf of European Society of Cardiology.
FAU - Elder, Douglas H J
AU  - Elder DH
AD  - Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical 
      School, University of Dundee, Dundee, UK.
FAU - Singh, Jagdeep S S
AU  - Singh JS
AD  - Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical 
      School, University of Dundee, Dundee, UK.
FAU - Levin, Daniel
AU  - Levin D
AD  - Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical 
      School, University of Dundee, Dundee, UK.
FAU - Donnelly, Louise A
AU  - Donnelly LA
AD  - Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical 
      School, University of Dundee, Dundee, UK.
FAU - Choy, Anna-Maria
AU  - Choy AM
AD  - Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical 
      School, University of Dundee, Dundee, UK.
FAU - George, Jacob
AU  - George J
AD  - Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical 
      School, University of Dundee, Dundee, UK.
FAU - Struthers, Allan D
AU  - Struthers AD
AD  - Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical 
      School, University of Dundee, Dundee, UK.
FAU - Doney, Alex S F
AU  - Doney AS
AD  - Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical 
      School, University of Dundee, Dundee, UK.
FAU - Lang, Chim C
AU  - Lang CC
AD  - Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical 
      School, University of Dundee, Dundee, UK.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20151213
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - *Diabetes Mellitus, Type 2/blood/complications/drug therapy/epidemiology
MH  - Female
MH  - Glycated Hemoglobin/*analysis
MH  - *Heart Failure/blood/complications/diagnosis/mortality
MH  - Humans
MH  - Hypoglycemic Agents/therapeutic use
MH  - Male
MH  - Metformin/*therapeutic use
MH  - Middle Aged
MH  - Monitoring, Physiologic/*methods
MH  - Mortality
MH  - Outcome Assessment, Health Care
MH  - Proportional Hazards Models
MH  - Risk Assessment/methods
MH  - United Kingdom/epidemiology
OTO - NOTNLM
OT  - Diabetes
OT  - HbA1c
OT  - Heart failure
OT  - Metformin
OT  - Outcomes
EDAT- 2015/12/15 06:00
MHDA- 2016/10/16 06:00
CRDT- 2015/12/15 06:00
PHST- 2014/11/27 00:00 [received]
PHST- 2015/10/23 00:00 [revised]
PHST- 2015/11/06 00:00 [accepted]
PHST- 2015/12/15 06:00 [entrez]
PHST- 2015/12/15 06:00 [pubmed]
PHST- 2016/10/16 06:00 [medline]
AID - 10.1002/ejhf.455 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2016 Jan;18(1):94-102. doi: 10.1002/ejhf.455. Epub 2015 Dec 13.