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Early glycaemic control and subsequent glycaemic stability improve cardiovascular outcomes in type 2 diabetes

Poor control in the first year of diagnosis and greater HbA1c variability thereafter confer the greatest risk.

This retrospective cohort study, using data from the RCGP Research and Surveillance Centre database, sought to elucidate the effects of glycaemic control within the first year of type 2 diabetes diagnosis, and subsequent trends in HbA1c variability, on cardiovascular outcomes.

A total of 26,180 adults with type 2 diabetes diagnosed between January 2005 and December 2016 were followed for a median of 4 years. Glycaemic control within the first year was categorised as good (<7.5%), moderate (7.5–9.0%) or poor (≥9.0%). Thereafter, HbA1c variability was defined by the number of times HbA1c differed between consecutive measurements by ≥5.5 mmol/mol (0.5%), adjusted for the number of measurements taken. The primary outcome was the first occurrence of major adverse cardiovascular events (MACE; myocardial infarction, coronary intervention, stroke or amputation/limb revascularisation).

The results showed that people whose HbA1c remained level or deteriorated in the first year were more likely to have a MACE event, while those whose HbA1c improved had fewer events. Subsequently, those with the greatest glycaemic variability had the greatest risk of MACE (a 51% increase compared with the lowest variability).

These findings reinforce the benefits of achieving good glycaemic control as soon as possible following diagnosis of type 2 diabetes. Thereafter, they highlight the importance of maintaining good glycaemic control over the longer term to mitigate future macrovascular risk.

Click here to read the study in full.

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