BACKGROUND Glycemic instability confers a risk of poor prognosis in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate whether HbA1c variability provided additional value over mean HbA1c for predicting subclinical left ventricular remodeling and dysfunction in T2DM patients. METHODS A total of 466 T2DM patients with normal cardiac structure and function were recruited and prospectively followed up for a median of 4.7 y. HbA1c was measured quarterly. The intrapersonal mean and standard deviation (SD) of HbA1c measurements were calculated, and SD-HbA1c was considered as a measure of HbA1c variability. All participants underwent transthoracic echocardiography at baseline and after follow-up. RESULTS In multivariable regression analyses, SD-HbA1c was independently associated with annualized changes in left ventricular end diastolic diameter, interventricular septum, left ventricular posterior wall, left ventricular mass index, left ventricular ejection fraction, E/e' ratio, and E/A ratio (P < 0.001). Subgroup analysis based on mean HbA1c levels (<7.0%, 7.0-7.5%, and ≥7.5%) further confirmed that SD-HbA1c was associated with most of the above parameters regardless of mean HbA1c levels. CONCLUSION This study indicates that HbA1c variability adds to the mean value in predicting subclinical left ventricular remodeling and dysfunction in T2DM patients.

中文翻译：

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HbA1c变异性对2型糖尿病患者亚临床左心室重构和功能障碍的影响。

背景技术血糖不稳定会给2型糖尿病（T2DM）患者带来不良预后的风险。这项研究旨在调查HbA1c变异性是否为预测T2DM患者的亚临床左心室重构和功能障碍提供了高于平均HbA1c的附加价值。方法总共466例心脏结构和功能正常的T2DM患者进行了前瞻性随访，中位时间为4.7年。HbA1c每季度测量一次。计算HbA1c测量值的人均平均值和标准差（SD），并将SD-HbA1c视为HbA1c变异性的量度。所有参与者在基线和随访后均接受经胸超声心动图检查。结果在多元回归分析中，SD-HbA1c与左心室舒张末期直径，心室间隔，左心室后壁，左心室质量指数，左心室射血分数，E / e'比和E / A比的年度变化独立相关（P <0.001） 。根据平均HbA1c水平（<7.0％，7.0-7.5％和≥7.5％）进行的亚组分析进一步证实，SD-HbA1c与上述大多数参数相关，而与平均HbA1c水平无关。结论这项研究表明HbA1c变异性增加了预测T2DM患者亚临床左心室重构和功能障碍的平均值。基于平均HbA1c水平（<7.0％，7.0-7.5％和≥7.5％）进行的亚组分析进一步证实，无论平均HbA1c水平如何，SD-HbA1c与上述大多数参数相关。结论这项研究表明HbA1c变异性增加了预测T2DM患者亚临床左心室重构和功能障碍的平均值。基于平均HbA1c水平（<7.0％，7.0-7.5％和≥7.5％）进行的亚组分析进一步证实，无论平均HbA1c水平如何，SD-HbA1c与上述大多数参数相关。结论这项研究表明HbA1c变异性增加了预测T2DM患者亚临床左心室重构和功能障碍的平均值。