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. 2022 Jan;38(1):e3485.
doi: 10.1002/dmrr.3485. Epub 2021 Jul 13.

Machine learning based study of longitudinal HbA1c trends and their association with all-cause mortality: Analyses from a National Diabetes Registry

Avivit Cahn  1   2 , Inbar Zuker  3   4 , Roni Eilenberg  5 , Moshe Uziel  5 , Meytal Avgil Tsadok  5 , Itamar Raz  1   2 , Miri Lutski  3   4
Affiliations

Machine learning based study of longitudinal HbA1c trends and their association with all-cause mortality: Analyses from a National Diabetes Registry

Avivit Cahn et al. Diabetes Metab Res Rev. 2022 Jan.

Abstract

Objective: The association of long-term HbA1c variability with mortality has been previously suggested. However, the significance of HbA1c variability and trends in different age and HbA1c categories is unclear.

Research design and methods: Data on patients with diabetes listed in the Israeli National Diabetes Registry during years 2012-2016 (observation period) were collected. Patients with >4 HbA1c measurements, type 1 diabetes, eGFR < 30mg/ml/min, persistent HbA1c < 6% or malignancy were excluded. Utilizing machine learning methods, patients were classified into clusters according to their HbA1c trend (increasing, stable, decreasing). Mortality risk during 2017-2019 was calculated in subgroups defined by age (35-54, 55-69, 70-89 years) and last HbA1c (≤7% and >7%) at end of observation period. Models were adjusted for demographic, clinical and laboratory measurements including HbA1c, standard deviation (SD) of HbA1c and HbA1c trend.

Results: This historical cohort study included 293,314 patients. Increased HbA1c variability (high SD) during the observation period was an independent predictor of mortality in patients aged more than 55 years (p < 0.01). The HbA1c trend was another independent predictor of mortality. Patients with a decreasing versus stable HbA1c trend had a greater mortality risk; this association persisted in all age groups in patients with HbA1c > 7% at the end of the observation period (p = 0.02 in age 35-54; p < 0.01 in aged >55). Patients with an increasing versus stable HbA1c trend had a greater mortality risk only in the elderly group (>70), yet in both HbA1c categories (p < 0.01).

Conclusions: HbA1c variability and trend are important determinants of mortality risk and should be considered when adjusting glycaemic targets.

Keywords: HbA1c trend; National Diabetes Registry; machine learning; mortality; type 2 diabetes.

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References

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