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. 2020 Mar-Apr;17(3):1479164120909030.
doi: 10.1177/1479164120909030.

Mean and variability of annual haemoglobin A1c are associated with high-risk peripheral artery disease

I-Te Lee  1   2   3   4
Affiliations

Mean and variability of annual haemoglobin A1c are associated with high-risk peripheral artery disease

I-Te Lee. Diab Vasc Dis Res. 2020 Mar-Apr.

Abstract

Background: Glucose variability is predictive of cardiovascular events and all-cause mortality. However, the association between peripheral artery disease and glucose variability has not been thoroughly investigated. Therefore, the standard deviation of annual haemoglobin A1c was assessed in patients with type 2 diabetes for evaluating the different risks of peripheral artery disease.

Methods: A total of 4144 patients underwent an evaluation for the ankle-brachial index and the percentage of mean arterial pressure at the ankle. The first haemoglobin A1c record was retrospectively collected from each year until the ankle-brachial index measurement.

Results: The standard deviation of annual haemoglobin A1c was higher in patients with ankle-brachial index ⩽0.90 than in those with ankle-brachial index >0.90 (1.1 ± 0.9% vs 1.0 ± 0.8%, p = 0.009) and was higher in patients with percentage of mean arterial pressure ⩾45% than in those with percentage of mean arterial pressure <45% (1.1 ± 0.8% vs 1.0 ± 0.8%, p = 0.007). A high standard deviation and mean of annual haemoglobin A1c are associated with high-risk peripheral artery disease, which is defined as a combination of ankle-brachial index ⩽0.90, percentage of mean arterial pressure ⩾45% or both (odds ratio = 1.306; 95% confidence interval = 1.057-1.615; p = 0.014).

Conclusion: Fluctuation in the haemoglobin A1c value indicates higher risk for peripheral artery disease in patients with type 2 diabetes and poor glucose control.

Keywords: Ankle-brachial index; haemoglobin A1c; percentage of the mean arterial pressure; peripheral artery disease; type 2 diabetes; variability.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram of the enrolment of study subjects. %MAP: percentage of the mean arterial pressure; ABI: ankle-brachial index; PAD: peripheral artery disease.
Figure 2.
Figure 2.
Percentage of patients with (a) high-risk peripheral artery disease (defined by a combination of ankle-brachial index (ABI) ⩽0.9, percentage of the mean arterial pressure (%MAP) ⩾45% or both), (b) ABI ⩽0.9 and (c) %MAP ⩾45% across the four patient groups categorized based on the median mean (7.4%) and median standard deviation (SD) (0.775%) of annual HbA1c.
Figure 3.
Figure 3.
Percentage of patients with high-risk peripheral artery disease across three patterns of HbA1c trajectory in patients with a mean annual HbA1c ⩾7.4%.
See this image and copyright information in PMC

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