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首页> 外文期刊>Diabetes care >Association of Long-term Change and Variability in Glycemia With Risk of Incident Heart Failure Among Patients With Type 2 Diabetes: A Secondary Analysis of the ACCORD Trial
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Association of Long-term Change and Variability in Glycemia With Risk of Incident Heart Failure Among Patients With Type 2 Diabetes: A Secondary Analysis of the ACCORD Trial

机译：糖尿病长期变化和变异性，患有2型糖尿病患者事件心力衰竭风险的糖尿病：ACCART试验的二级分析

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OBJECTIVE To evaluate the associations between long-term change and variability in glycemia with risk of heart failure (HF) among patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Among participants with T2DM enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, variability in HbA(1c)was assessed from stabilization of HbA(1c)following enrollment (8 months) to 3 years of follow-up as follows: average successive variability (ASV) (average absolute difference between successive values), coefficient of variation (SD/mean), and SD. Participants with HF at baseline or within 3 years of enrollment were excluded. Adjusted Cox models were used to evaluate the association of percent change (from baseline to 3 years of follow-up) and variability in HbA(1c)over the first 3 years of enrollment and subsequent risk of HF. RESULTS The study included 8,576 patients. Over a median follow-up of 6.4 years from the end of variability measurements at year 3, 388 patients had an incident HF hospitalization. Substantial changes in HbA(1c)were significantly associated with higher risk of HF (hazard ratio [HR] for >= 10% decrease 1.32 [95% CI 1.08-1.75] and for >= 10% increase 1.55 [1.19-2.04]; reference <10% change in HbA(1c)). Greater long-term variability in HbA(1c)was significantly associated with higher risk of HF (HR per 1 SD of ASV 1.34 [95% CI 1.17-1.54]) independent of baseline risk factors and interval changes in cardiometabolic parameters. Consistent patterns of association were observed with use of alternative measures of glycemic variability. CONCLUSIONS Substantial long-term changes and variability in HbA(1c)were independently associated with risk of HF among patients with T2DM.
机译：目的探讨糖尿病患者心力衰竭（HF）长期变化与变异性的关联，患有2型糖尿病（T2DM）。研究设计和方法在患有糖尿病（ACCORD）试验中控制心血管风险的动作中的参与者的参与者（Accord）试验中，从入学（8个月）至3年后，从HBA（1C）的稳定化评估HBA（1C）的变异性 - 如下：平均连续变异性（ASV）（连续值之间的平均绝对差异），变异系数（SD /平均值）和SD。除了基线或3年内的招收到3年内的参与者被排除在外。调整后的COX模型用于评估在入学率的前3年和后续风险的HBA（1C）中变化（从基线到3年的后续后续跟踪）和变异性。结果该研究包括8,576名患者。在3年度从可变性测量结束时在6.4岁的中间后续行动，388名患者发生了HF住院病。 HBA（1C）的大量变化与HF的风险显着相关（危险比[HR]> = 10％的降低1.32 [95％CI 1.08-1.75]和> = 10％增加1.55 [1.19-2.04];参考HBA（1C）的<10％的变化））。 HBA（1C）中的更大的长期变异性与HF的风险较高相关（每1SV 1.34的HR [95％CI 1.17-1.54]），与基线风险因素和心细镜参数的间隔变化无关。通过使用替代血糖可变性的替代测量，观察到一致的关联模式。结论HBA（1C）中的大量长期变化和变异性与T2DM患者患者的HF风险与HB的风险无关。

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