HbA1c predicts long-term postoperative mortality in patients with unknown glycemic status at admission for vascular surgery: An exploratory study

J Diabetes. 2019 Jun;11(6):466-476. doi: 10.1111/1753-0407.12873. Epub 2018 Nov 26.

Abstract
in English, Chinese

Background: Peripheral arterial disease (PAD) and diabetes mellitus (DM) represent major public health challenges and are tightly associated. To facilitate early diagnosis, HbA1c has been implemented as the preferred diagnostic tool for the diagnosis of type 2 DM. In this study, we compared and evaluated HbA1c, fasting plasma glucose (FPG), and 2-hour post-load glucose values to determine which test best predicted mortality in patients with PAD.

Methods: In all, 273 PAD patients with unknown glycemic status admitted to Haukeland University Hospital for elective surgery between October 2006 and September 2007 were included in the study. All 273 patients underwent a standard oral glucose tolerance test (OGTT) in addition to determination of HbA1c; patients were then grouped into those with DM, intermediate hyperglycemia, and normoglycemia according to World Health Organization and International Expert Committee criteria.

Results: All-cause mortality was 40% over a 9-year follow-up period. After adjusting for age, sex, and relevant medication, HbA1c was a predictor for mortality (hazard ratio [HR] 1.54; 95% confidence interval [CI] 1.03-2.32]; P = 0.04). The association did not achieve statistical significance in a fully adjusted Cox regression model, although the effect estimation of HbA1c on all-cause mortality remained largely unchanged (HR 1.39; 95% CI 0.92-2.09; P = 0.13). The OGTT was not a predictor of long-term mortality.

Conclusions: The results indicate that HbA1c is a useful marker in the preoperative screening of patients of unknown glycemic status at the time of admission for vascular surgery, and may identify people at high risk of long-term mortality following surgical treatment for PAD.

摘要: 背景 外周动脉疾病(Peripheral arterial disease，PAD)与糖尿病对公共卫生来说都是重大的挑战，且两者紧密相关。为了便于早期诊断，将检测HbA1c作为诊断2型糖尿病的首选诊断方法。在本研究中，为了明确哪种检测方法能够最好地预测PAD患者的死亡率，我们对HbA1c、空腹血糖以及负荷后2小时血糖值进行了比较与评估。 方法 这项研究在2006年10月至2007年9月期间共纳入了273名收住在霍克兰大学附属医院进行择期手术的PAD患者，他们入院时的血糖状态未知。所有273名患者都要进行标准的口服葡萄糖耐量试验(OGTT)和HbA1c测定；根据世界卫生组织与国际专家委员会的标准将患者分组为糖尿病组、中间高血糖组与正常血糖组。 结果 在超过9年的随访期间，全因死亡率为40%。校正年龄、性别以及相关药物后，发现HbA1c可以预测死亡率(风险比[HR]为1.54；95%置信区间[CI]为1.03-2.32]；P = 0.04)。在完全校正后的Cox回归模型中，这种相关性没有显著的统计学意义，尽管HBA1c对全因死亡率估计的影响基本不变(HR为1.39；95% CI为0.92-2.09；P = 0.13)。OGTT结果并不能够预测长期死亡率。 结论 这项研究结果表明，对于入院时血糖状态未知的患者来说，在血管手术前筛查的HbA1c是一个有用的标志物，并且可以用来鉴别PAD手术治疗后长期死亡率处于较高风险的人群。.

Keywords: HbA1c; diabetes; mortality; peripheral arterial disease; 外周动脉疾病; 死亡率; 糖尿病.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / analysis
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / mortality*
  • Female
  • Follow-Up Studies
  • Glucose Intolerance / blood
  • Glucose Intolerance / epidemiology
  • Glucose Intolerance / mortality*
  • Glucose Tolerance Test
  • Glycated Hemoglobin / analysis*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Norway / epidemiology
  • Peripheral Arterial Disease / mortality*
  • Peripheral Arterial Disease / pathology
  • Peripheral Arterial Disease / surgery
  • Postoperative Complications / mortality*
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Survival Rate
  • Vascular Surgical Procedures / mortality*

Substances

  • Biomarkers
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human