HbA1c降低0.8% 5年死亡率减半

柏林——瑞典哥德堡大学的Katarina Eeg-Olofsson博士在欧洲糖尿病研究协会(EASD)年会报告，对于血糖控制欠佳的患者，只需将其糖化血红蛋白A1c(HbA1c)数值降低0.8%的微小幅度，则患者的5年死亡率就能比较HbA1c无改善的患者降低50%。

Katarina Eeg Olofsson博士

这是一项对12,359例基线时血糖控制较差的2型糖尿病患者的观察性研究，患者来自瑞典国家糖尿病注册系统，研究者使用瑞典死亡原因和医院注册系统核实患者的结局。基线时，无一患者合并心血管疾病或冠心病。患者被分为2组：5年期间HbA1c降低至少0.1%的患者(6,841例)和5年期间保持稳定或升高至少0.1%的患者(5,518例)。基线时，患者平均年龄为62岁，平均疾病病程为9年。基线时的平均HbA1c为7.8%，平均体重指数为30 kg/m2。平均血压为140/78 mmHg；62%在接受降压药物治疗，46%在接受降脂药物治疗。

结果显示，5年后，控制改善组的平均HbA1c为7%(-0.8%)，控制较差组为8.4%(0.7%)。5年时，控制良好组和控制较差组分别有12%和20%的患者发生冠心病，两组分别有17%和30%的患者发生心血管疾病。这些结果均具有统计学差异。经校正基线危险因素和研究期间的治疗变化后，研究者发现HbA1c降低者发生心血管疾病或冠心病的几率为HbA1c水平升高者的一半。与血糖控制较差组相比，其发生致死性心血管疾病的几率减少了33%；5年时，HbA1c无改善组和HbA1c改善组的全因死亡率分别为15%和10%，HbA1c改善组因任何原因死亡的几率减少了41%。所有上述差异均具有统计学意义。

研究者认为，“很明显，血糖控制较差的2型糖尿病患者将受益于”血糖控制和改善。“我们必须努力提前识别对糖尿病药物治疗无应答的患者。”

Eeg-Olofssson博士披露无相关利益冲突。

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By: MICHELE G. SULLIVAN, Cardiology News Digital Network

BERLIN – Patients who had suboptimal glycemic control and reduced their hemoglobin A1c value by slightly less than 1% were 50% less likely to die within 5 years than were patients whose HbA1c did not improve, Dr. Katarina Eeg-Olofsson reported.

At 5 years, all-cause mortality was 15% among the group with no improvement in HbA1c and 10% in the group with improved HbA1c in an observational study of 12,359 patients with poorly controlled type 2 diabetes at baseline. The patients were selected from the Swedish National Diabetes Registry and their outcomes were verified by the Swedish Cause of Death and Hospital Registries. None of the patients had any cardiovascular or coronary heart disease at baseline.
 
After adjusting for baseline risk factors and treatment changes during the study period, patients whose HbA1c decreased were half as likely to develop cardiovascular or coronary heart disease as were those whose levels increased. They were also 33% less likely to experience fatal cardiovascular disease and 41% less likely to die from any cause than were those in the poorly controlled group. All of these differences were statistically significant, she said at the annual meeting of the European Association for the Study of Diabetes.

"Patients with poorly controlled blood glucose clearly benefit" from gaining and improving glycemic control, said Dr. Eeg-Olofsson of the University of Gothenburg, Sweden. "We must make an effort to identify patients who don’t respond to diabetes medications earlier."

For the study, Dr. Eeg-Olofssson separated the patients into two groups: Those whose HbA1c decreased by at least 0.1% over the 5 years (6,841) and those whose HbA1c remained stable or increased by at least 0.1% (5,518).

At baseline, the patients averaged 62 years old, with mean disease duration of 9 years. Their average baseline HbA1c was 7.8%, and their mean body mass index was 30 kg/m2. Their mean blood pressure was 140/78 mmHg; 62% were taking antihypertensives and 46% were on lipid-lowering drugs.

After 5 years, mean HbA1c was 7% in the improved-control group (-0.8%) and 8.4% in the poorly controlled group (+0.7%), she said.

By then, 12% of the well-controlled group and 20% of the poorly controlled group had developed coronary heart disease. Cardiovascular disease was present in 17% of those in the well-controlled group and 30% of the poorly controlled group. Both these findings were statistically significant.

Dr. Eeg-Olofssson had no financial disclosures.