Key result
Metabolically unhealthy profiles are linked to a distinct co-association of HbA1c, hypertension, and arterial stiffness.
Why the study?
The study evaluated the relevance of the triple co-association of HbA1c, arterial stiffness, and hypertension for risk stratification and screening in regular standard care.
Does a clustered metabolic approach using HbA1c, BP, and aortic augmentation index differentiate metabolically healthy from unhealthy patients with Type 2 Diabetes?
Observational (n=2,000)
Does a clustered metabolic approach using HbA1c, BP, and aortic augmentation index differentiate metabolically healthy from unhealthy patients with Type 2 Diabetes?
p-value: p=0.0457
A clustered metabolic approach combining HbA1c, blood pressure, and arterial stiffness can significantly differentiate metabolically healthy from unhealthy patients with Type 2 diabetes for risk stratification.
May support clustered HbA1c-BP-stiffness profiling for T2D risk stratification; hypothesis-generating and requires prospective validation before practice change.
Materials and Methods: Functional vascular age in 2000 patients was assessed using cardiac risk profiler (vascular profiler-genesis), over a period of 3 years and 3 months between October 2016 and January 2020. The cardiovascular interpretations generated were used for the measurement of central arterial stiffness. The metabolically healthy groups were compared with the metabolically nonhealthy groups for the relevance of the triple co-association of HbA1c, arterial stiffness, and hypertension in screening the patients in regular standard care. The mean age of the patients was 53 years. Mann–Whitney test was used for the statistical analysis. Results: The mean age was 53.3 ± 12 years. HbA1c was <7% and >7% in 530 and 1470 patients, respectively. The lipid profile in comorbid scenario ( n = 2000 [M = 1170 and F = 830]) revealed mean LDL-C mg/dL values of< 100, 100–150, >150 in 1380, 520, and 100 patients, respectively. A total of 1000 patients had the duration of diabetes <5 years, 380 patients were between 5 and 10 years, and 620 patients had been diabetic for>10 years, respectively. Arterial stiffness markers-Ankle Brachial Index and Carotid-Femoral Pulse Wave Velocity (CFPWV) were assessed and cluster analyses was performed using the metabolically healthy (HbA1c <7 and aortic augmentation index @ HR75 < 14 and nonhypertensive n = 50) as compared to the metabolically unhealthy cohort (HbA1c >7 and aortic augmentation index @ HR75 > 14 and with known hypertension ( n = 230). The difference in the triple co-association of HbA1c (glycemic status), hypertensive status, and arterial stiffness was statistically significant when compared between the metabolically healthy ( n = 50) vs. the metabolically nonhealthy cohort all across ( n = 230) ( P = 0.0457) Conclusion: The clustered metabolic marker approach is a tool to identify and stratify patients with diabetes based on the metabolic risk to prevent complications and possibly improve outcomes.
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Chawla et al. (2021) conducted an observational in Type 2 Diabetes (n=2,000). Metabolically unhealthy status (HbA1c >7, aortic augmentation index @ HR75 > 14, and known hypertension) vs. Metabolically healthy status (HbA1c <7, aortic augmentation index @ HR75 < 14, and nonhypertensive) was evaluated on Difference in the triple co-association of HbA1c, hypertensive status, and arterial stiffness (p=0.0457). A metabolically unhealthy profile was significantly different in the triple co-association of HbA1c, hypertension, and arterial stiffness compared to a metabolically healthy cohort (P=0.0457).
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