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011 HbA1c and mortality in diabetic individuals with heart failure: an observational cohort study
  1. D H J Elder,
  2. L Donnelly,
  3. A Wong,
  4. B R Szwejkowski,
  5. M Pauriah,
  6. T K Lim,
  7. S D Pringle,
  8. A Choy,
  9. E Pearson,
  10. A Morris,
  11. J George,
  12. A Struthers,
  13. C Palmer,
  14. A Doney,
  15. C C Lang
  1. University of Dundee, Dundee, UK

Abstract

Background Controversy exists regarding the importance of glycaemic control in patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) based on conflicting reports that had used a single baseline HbA1c.

Objective To examine the relationship between the mean of all HbA1c measures after CHF diagnosis and outcome in a large cohort of T2DM patients with incident CHF.

Design Retrospective, observational cohort study.

Setting Tayside, Scotland.

Patients T2DM patients with incident CHF between 1993 and 2010.

Measurement A weighted mean HbA1c was calculated using all available HbA1c measures following CHF diagnosis and patients were grouped into five categories of HbA1c (≤6%, >6–≤7%, >7–≤8%, >8–≤9% and >9%). We subsequently compared diet and drug treated populations. The relationship between mean HbA1c and all-cause deaths after CHF diagnosis was assessed.

Results 795 patients with T2DM met study criteria. Median follow-up of 3.8 years saw 491 (61.8%) deaths. Cox regression model, adjusted for all other significant predictors, with the middle HbA1c category (>7–≤8%) as the reference, showed a U shaped relationship between HbA1c and outcome. (<6% [HR 95% CI 1.78 (1.26 to 2.52)]; >6–≤7% [1.29 (1.01 to 1.66)] and >9% [1.38 (1.03 to 1.84)]. We found a similar relationship in the drug treated sub-group. However in the diet only group, low HbA1c was associated with the lowest risk of death (≤7% [0.17 (0.07 to 0.39)]).

Conclusions In patients with T2DM and CHF, our observational study shows that in drug treated patients there was a U shaped relationship between HbA1c and mortality with the lowest mortality risk in patients with modest glycaemic control (HbA1c, >7–≤9%). However in diet treated patients, lower HbA1c was associated with lower mortality risk.

  • Diabetes
  • heart failure
  • outcome

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