Mean HbA1c and mortality in diabetic individuals with heart failure: a population cohort study
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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.
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A similar U-shaped curve was found in a single-centre study from Scotland.
“A similar U-shaped curve was found in a single-centre study from Scotland.105”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [105]
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- Authors
- Elder, D. H. J., Singh, J. S. S., Levin, D., Donnelly, L. A., Choy, A.-M., George, J., Struthers, A. D., Doney, A. S. F., & Lang, C. C.
- Affiliations
- University of Dundee (GB)
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee , Dundee ,
- Corresponding author
- Lang, Chim C.
- ORCID
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-12-13
- Volume
- 18
- Issue
- 1
- Pages
- 94-102
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W2218334377
- Cited by
- 109
- References
- 51
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 12 · 2023: 5 · 2022: 4 · 2021: 20 · 2020: 17 · 2019: 14 · 2018: 18 · 2017: 6 · 2016: 3
- FWCI
- 7.81
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Heart Failure (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion, cc-by-nc-nd)
- Funders
- University of Dundee
- European Foundation for the Study of Diabetes
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- glycemic control, type 2 diabetes, chronic heart failure, all-cause mortality, insulin sensitizers, metformin, U-shaped relationship, diabetes complications, mortality risk stratification, cardiovascular risk stratification, HbA1c
- MeSH terms
- Aged, Aged, 80 and over, Diabetes Mellitus, Type 2, Female, United Kingdom, Heart Failure, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Metformin, Middle Aged, Monitoring, Physiologic, Mortality, Cohort Studies, Proportional Hazards Models, Outcome Assessment, Health Care, Risk Assessment
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