van Wijngaarden RPT, et al. - The association between different measures of glycemic exposure and micro- and macrovascular complications in type 2 diabetes was investigated in a cohort of diabetics enrolled in a retrospective study. An increased risk of micro- and macrovascular complications was observed in association with greater and more prolonged exposure to hyperglycemia.

Methods

• Researchers performed this study on patients receiving oral antihyperglycemic agents between 1 January 2006 and 31 December 2014 from the General Practitioner Database from the PHARMO Database Network.
• They used all recorded HbA1c levels during follow-up in order to express glycemic exposure in four ways: index HbA1c, time-dependent HbA1c, exponential moving average (EMA) and glycemic burden.
• They assessed the link between glycemic exposure and micro-/macrovascular complications by estimating hazard ratios and 95% confidence intervals using an adjusted (time-dependent) Cox proportional hazards model.

Results

• A total of 32,725 patients (median age, 65 years; 47% female) were included in this study.
• As per data, median follow-up was 5.4 years; median number of HbA1c measurements per patient was 18.0.
• Findings demonstrated that, from all measures, HbA1c at index displayed the weakest association between all micro-/macrovascular complications, with coronary artery disease (CAD) having the highest HR (95% CI): 1.18 (1.04–1.34) for HbA1c ≥64 mmol/mol (8%).
• In addition, a significant association only for microvascular complications was demonstrated in time-dependent HbA1c model, with retinopathy having the highest HR (95% CI): 1.55 (1.40–1.73) for HbA1c ≥64 mmol/mol (8%).
• Researchers observed that EMA-defined exposure demonstrated similar results, although the impact of retinopathy was more pronounced [HR (95% CI): 1.81 (1.63–2.02) for HbA1c ≥64 mmol/mol (8%)] and was also predictive for CAD [HR (95% CI): 1.29 (1.10–1.50) for HbA1c ≥64 mmol/mol (8%)].
• Results highlighted a statistically significant association with glycemic burden for all selected micro-/macrovascular complications, with retinopathy having the highest HR (95%): 2.60 (2.19–3.07) for glycemic burden years >3.