Evaluation of HbA1c trend analysis as a Prognostic Tool in type 2 diabetes mellitus

Siobhan Fitzgerald; N. Fitzgerald; N. Doyle

doi:10.5281/zenodo.22812628

Authors

Siobhan Fitzgerald Department of Diabetes and Endocrinology, Rhine Academy of Metabolic Disease Author https://orcid.org/5994-1802-9779-8871
N. Fitzgerald Division of Diabetes and Endocrinology, Colorado Institute for Advanced Diabetes and Endocrinology Author https://orcid.org/9746-9901-5328-3947
N. Doyle Department of Diabetes and Endocrinology, Ebro Academy of Diabetes and Endocrinology Author https://orcid.org/6705-3954-9075-0167

DOI:

https://doi.org/10.5281/zenodo.22812628

Keywords:

HbA1c, glycemic variability, type 2 diabetes mellitus, prognosis, cardiovascular outcomes

Abstract

Graphical abstract

Background: Glycated haemoglobin (HbA1c) is the standard measure of glycaemic control in type 2 diabetes mellitus (T2DM), and landmark trials linked sustained elevation to microvascular and macrovascular risk [2,3]. The longitudinal trend and visit-to-visit variability of HbA1c are increasingly examined as independent prognostic signals.

Objective: This review evaluates HbA1c trend and variability analysis as a prognostic tool for mortality and vascular complications in T2DM, compared with single-timepoint HbA1c and continuous glucose monitoring (CGM) metrics.

Methods: We synthesized major randomized trials, prospective and retrospective cohorts, and registry analyses addressing HbA1c trajectory, variability, and outcomes in adults with T2DM.

Findings: Higher HbA1c variability independently predicts all-cause mortality and cardiovascular events after adjustment for mean HbA1c [10,11,12], with hazard ratios of 1.5-2.5 for highest versus lowest variability strata. Registry data show a U-shaped mean HbA1c-mortality association, with risk rising at both extremes [16]. CGM-derived metrics complement but do not replace HbA1c trend analysis [26,27].

Conclusions: HbA1c trend and variability analysis adds independent prognostic information beyond a single measurement and should inform risk stratification in T2DM [17,13].

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