Long-Term Risk of Cardiovascular Disease Among Type 2 Diabetes Patients According to Average and Visit-to-Visit Variations of HbA1c Levels During the First 3 Years of Diabetes Diagnosis

Background: It remains unclear whether a combination of glycemic variability and glycated hemoglobin (HbA1c) status leads to a higher incidence of cardiovascular disease (CVD).Therefore, to investigate CVD risk according to the glucose control status during early diabetes, we examined visit-to-visit HbA1c variability among patients with type 2 diabetes (T2DM).Methods: In this 9-year retrospective study, we measured HbA1c levels at each visit and tracked the change in HbA1c levels for 3 years after the first presentation (observation window) in newly diagnosed T2DM patients.We later assessed the occurrence of CVD in the last 3 years (target outcome window) of the study period after allowing a 3-year buffering window.The HbA1c variability score (HVS; divided into quartiles, HVS_Q1-4) was used to determine visit-to-visit HbA1c variability.Results: Among 4,817 enrolled T2DM patients, the mean HbA1c level was < 7% for the first 3 years.The group with the lowest HVS had the lowest rate of CVD (9.4%; 104/1,109 patients).The highest incidence of CVD of 26.7% (8/30 patients) was found in HVS [ 9.0%]_Q3, which was significantly higher than that in HVS [6.0-6.9%]_Q1(P = 0.006), HVS [6.0-6.9%]_Q2(P = 0.013), HVS [6.0-6.9%]_Q3(P = 0.018), and HVS [7.0-7.9%]_Q3(P = 0.040). Conclusion:To our knowledge, this is the first long-term study to analyze the importance of both HbA1c change and visit-to-visit HbA1c variability during outpatient visits within the first 3 years.Lowering glucose levels during early diabetes may be more critical than reducing visit-to-visit HbA1c variability.