@article{6e54114087f84b88af0aa65741af290b,
title = "Association of long-term change and variability in glycemia with risk of incident heart failure among patients with type 2 diabetes: A secondary analysis of the ACCORD trial",
abstract = "OBJECTIVE To evaluate the associations between long-term change and variability in glycemia with risk of heart failure (HF) among patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Among participants with T2DM enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, variability in HbA1c was assessed from stabilization of HbA1c following enrollment (8 months) to 3 years of follow-up as follows: average successive variability (ASV) (average absolute difference between successive values), coefficient of variation (SD/mean), and SD. Participants with HF at baseline or within 3 years of enrollment were excluded. Adjusted Cox models were used to evaluate the association of percent change (from baseline to 3 years of follow-up) and variability in HbA1c over the first 3 years of enrollment and subsequent risk of HF. RESULTS The study included 8,576 patients. Over a median follow-up of 6.4 years from the end of variability measurements at year 3, 388 patients had an incident HF hos-pitalization. Substantial changes in HbA1c were significantly associated with higher risk of HF (hazard ratio [HR] for ‡10% decrease 1.32 [95% CI 1.08–1.75] and for ‡10% increase 1.55 [1.19–2.04]; reference <10% change in HbA1c). Greater long-term variability in HbA1c was significantly associated with higher risk of HF (HR per 1 SD of ASV 1.34 [95% CI 1.17–1.54]) independent of baseline risk factors and interval changes in cardiometabolic parameters. Consistent patterns of association were observed with use of alternative measures of glycemic variability. CONCLUSIONS Substantial long-term changes and variability in HbA1c were independently associated with risk of HF among patients with T2DM.",
author = "Segar, {Matthew W.} and Patel, {Kershaw V.} and Muthiah Vaduganathan and Caughey, {Melissa C.} and Javed Butler and Fonarow, {Gregg C.} and Grodin, {Justin L.} and McGuire, {Darren K.} and Ambarish Pandey",
note = "Funding Information: by the Texas Health Resources Clinical Scholars Program. A.P. is supported by the Texas Health Resources Clinical Scholars Program. Duality of Interest. M.V. serves on advisory boards for Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, and Boehringer Ingelheim and participates on clinical end point committees for studies sponsored by Novartis. J.B. serves as a consultant for Amgen, Array, AstraZeneca, Bayer AG, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, G3 Pharmaceuticals, INNOLIFE, Janssen, Luitpold Pharmaceuticals, Medtronic, Merck, Novartis, Relypsa, Stealth Peptides, SC Pharma, Vifor Pharma, and ZS Pharma. G.C.F. reports consulting for Abbott, Amgen, Bayer AG, CHF Solutions, Janssen, Medtronic, and Novartis. J.L.G. reports honoraria for consulting for Pfizer. D.K.M. reports honoraria for trial leadership from Astra-Zeneca, Sanofi, Janssen, Boehringer Ingelheim, Merck & Co, Pfizer, Novo Nordisk, Lexicon, Eisai, Glaxo-SmithKline, and ESPERION Therapeutics and honoraria for consulting for AstraZeneca, Sanofi, Lilly USA, Boehringer Ingelheim, Merck & Co, Pfizer, Novo Nordisk, Applied Therapeutics, Afimmune, and Meta-vant Sciences. A.P. has served on the advisory board of Roche Diagnostics. No other potential conflicts of interest relevant to this article were reported. Author Contributions. M.W.S., K.V.P., and A.P. developed the study concept and design, interpreted the data, and critically revised and drafted the manuscript. M.V., M.C.C., J.B., G.C.F., J.L.G., and D.K.M. contributed to the discussion and critically revised and reviewed the manuscript. M.W.S. and A.P. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented in abstract form at the American Heart Association Scientific Sessions 2019, Philadelphia, PA, 16–18 November 2019. Funding Information: Funding.K.V.P.issupportedbyaNationalHeart, Lung, and Blood Institute T32 postdoctoral training grant (5T32HL125247-03). M.V. is supported by the KL2/Catalyst Medical Research Investigator Training Award from Harvard Catalyst (National Institutes of Health [NIH]/National Center for Advancing Translational Sciences, UL 1TR002541). M.V. participates on clinical end point committees for studies sponsored by the NIH. J.B. has received research support from the NIH, Patient-Centered Outcomes Research Institute, and the European Union. J.L.G. is supported Funding Information: K.V.P.is supportedby a National Heart, Lung, and Blood Institute T32 postdoctoral training grant (5T32HL125247-03). M.V. is supported by the KL2/Catalyst Medical Research Inves-tigator Training Award from Harvard Catalyst (National Institutes of Health [NIH]/National Center for Advancing Translational Sciences, UL 1TR002541). M.V. participates on clinical end point committees for studies sponsored by the NIH. J.B. has received research support from the NIH, Patient-Centered Outcomes Research Institute, and the European Union. J.L.G. is supported by the Texas Health Resources Clinical Scholars Program. A.P. is supported by the Texas Health Resources Clinical Scholars Program. Publisher Copyright: {\textcopyright} 2020 by the American Diabetes Association.",
year = "2020",
month = aug,
doi = "10.2337/dc19-2541",
language = "English (US)",
volume = "43",
pages = "1920--1928",
journal = "Diabetes care",
issn = "0149-5992",
publisher = "American Diabetes Association Inc.",
number = "8",
}