The True Value of HbA1c as a Predictor of Diabetic Complications: Simulations of HbA1c Variables |
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| Authors: | Marcus Lind Anders Odén Martin Fahlén Bj?rn Eliasson |
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| Affiliation: | 1. Department of Medicine, Uddevalla Hospital, Uddevalla, Sweden.; 2. Department of Mathematical Sciences, Chalmers University of Technology, Göteborg, Sweden.; 3. Department of Medicine, Kungälv Hospital, Kungälv, Sweden.; 4. Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.;National Institute of Child Health and Human Development/National Institutes of Health, United States of America |
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| Abstract: | AimThe updated mean HbA1c has been used in risk estimates of diabetic complications, but it does not take into account the temporal relationship between HbA1c and diabetic complications. We studied whether the updated mean HbA1c underestimated the risk of diabetic complications.MethodContinuous HbA1c curves for 10,000 hypothetical diabetes patients were simulated over an average of 7 years. Simulations were based on HbA1c values encountered in clinical practice. We assumed that each short time interval of the continuous HbA1c curves had a long-lasting effect on diabetic complications, as evidenced by earlier studies. We tested several different HbA1c variables including various profiles, e.g. different duration, of such a long-lasting effect. The predictive power of these variables was compared with that of the updated mean HbA1c.ResultsThe predictive power of the constructed HbA1c variables differed considerably compared to that of the updated mean HbA1c. The risk increase per standard deviation could be almost 100% higher for a constructed predictor than the updated mean HbA1c.ConclusionsThe importance of good glycemic control in preventing diabetic complications could have been underestimated in earlier hallmark studies by not taking the time-dependent effect of HbA1c into account. |
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