Lack of glycemic control measures, a new risk factor for the development of cardiovascular disease in patients with type 2 diabetes

Fernando Alvarez-Guisasola, Elena Caride-Miana, Ismael Fernández-Antón, Escarlata Angullo-Martínez, Domingo Orozco-Beltrán

Keywords: Type 2 diabetes mellitus. Hemoglobin A1c. Cardiovascular disease.

Several studies focused on the relationship between glycated hemoglobin (A1C) levels and type 2 diabetes mellitus (T2D) complications. Many studies rate patients according to their A1c levels and complications and/or mortality. However, there isn't a clear categorization and neither an individualized study of those patients who don't have registered glycemic controls in their follow up.

Research questions:
Is it possible that T2D patients with lack of glycemic controls in their follow up, are those with higher cardiovascular risk?
The aim is to analyze whether the lack of glycemic controls in the diabetic patient implies a greater risk of cardiovascular events and mortality.

Observational analytical cohort study using a database of 25,895 patients with T2D, older than 30 years included in electronic medical records, with a maximum follow-up of 5 years (January 1, 2008 to December 31, 2012). Data were collected and checked with other registries. The main variable was the A1c value or its absence. The characteristics of patients and concomitant diseases were also analyzed.

Mean age 63.5 years (range 30-94), men 55.7%, follow-up 4.45 years, BMI 30.6, DBP and DSP 79.4 and 139.8 mmHg respectively, HDL-c and LDL-c 48.8 and 119.2 mg/dl, total cholesterol and triglycerides 199.2 and 157.9. Associated pathologies: atrial fibrillation 1%, hypertension 79.4%, dyslipidemia 77.6%, heart failure 6.4%, PAD 6.3%. Total events 2839 (12.9%). A Kaplan Meier curve was performed. Patients without an A1c assessment have a longer survival at the beginning of the period and a lower survival at the end of it. The whole period was divided into three time windows to which was applied the Cox multivariate regression model. Showing the longer period (> 4.25 years), HR 2,581 (95% CI 1,676-3,935), overcoming the rest of the groups.

T2D Patients who don't perform glycemic controls, are at higher cardiovascular risk, overcoming patients with poor glycemic control.

Points for discussion:
Lack of clinical follow up linked with poor metabolic control

Lack of clinical follow up linked with increased cardiovascular disease

Lack of clinical follow up linked with increased mortality