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Relationship between HbA 1c and risk of all‐cause hospital admissions among people with Type 2 diabetes
Author(s) -
Yu D.,
Simmons D.
Publication year - 2013
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12235
Subject(s) - medicine , diabetes mellitus , type 2 diabetes , emergency medicine , gerontology , endocrinology
Aim To investigate the relationship between HbA 1c and the 2‐year risk of hospitalization among people with Type 2 diabetes. Methods In total, 4704 patients from 18 general practices in Cambridgeshire were included. Glycaemic exposure was assessed in 2008–2009. The primary outcome was all‐cause hospital admissions in 2010–2011. Adjusted relative risks for each HbA 1c quintile were estimated using Cox models. Further relationships between HbA 1c and risks were explored using spline models. Results There was a non‐linear relationship between HbA 1c and the risk of all‐cause, diabetes and vascular admissions (all P < 0.001 for linearity test) with an HbA 1c threshold of 61 (95% CI 55–66) mmol/mol [7.7 (95% CI 7.2–8.2)%]. For every 11 mmol/mol (1%) HbA 1c above the threshold, the risks increased by 6.3% for all‐cause admission, 6.4% for a diabetes admission and 15.9% for a cardiovascular admission (all P < 0.001). The overall hospitalization risks of having an HbA 1c above, rather than at, the threshold, were 19.1 16.3 and 54.3% greater, respectively. There were non‐significantly greater risks of hospital admission below the threshold. Conclusion In people with Type 2 diabetes, a non‐linear relationship exists between HbA 1c and the risk of hospitalization. A threshold of 61 mmol/mol (7.7%) was associated with the lowest rate of all‐cause hospital admissions. Further research should investigate the causes of admissions below and above this threshold, with a view to developing strategies to reduce the excess hospitalization among patients with diabetes.