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Repeat measurements of glycated haemoglobin A 1c and N‐terminal pro‐B‐type natriuretic peptide: divergent behaviour in diabetes mellitus
Author(s) -
Neuhold Stephanie,
Resl Michael,
Huelsmann Martin,
Strunk Guido,
Adlbrecht Christopher,
Rath Claus,
Prager Rudolf,
Luger Anton,
Clodi Martin,
Pacher Richard
Publication year - 2011
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2011.02539.x
Subject(s) - medicine , natriuretic peptide , diabetes mellitus , glycated hemoglobin , proportional hazards model , type 2 diabetes mellitus , prospective cohort study , cardiology , endocrinology , clinical endpoint , type 2 diabetes , glycated haemoglobin , heart failure , clinical trial
Eur J Clin Invest 2011; 41 (12): 1292–1298 Abstract Background Patients with diabetes mellitus have a substantially increased risk of developing cardiovascular disease. However, the absolute risk greatly varies not only among patients, but the risk profile for an individual patient may also change over time. We investigated the prognostic role of repetitive measurements of Glycated haemoglobin A 1c (HbA 1c ) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in patients with longstanding diabetes. Materials and methods For this prospective, observational study data from 544 consecutive patients were collected between 2005 and 2008. HbA 1c and NT‐proBNP were measured at baseline and after 1 year. The median observation period was 40 months. Endpoints were all‐cause mortality, cardiac, cardiovascular and all‐cause hospitalizations. Results N‐terminal pro‐B‐type natriuretic peptide concentrations significantly increased from 230 ± 385 to 280 ± 449 pg mL −1 ( P < 0·001); during the same time, HbA 1c significantly decreased from 7·6 ± 1·5 to 7·3 ± 1·2 ( P < 0·001). NT‐proBNP was the best baseline predictor in a Cox regression model consisting of NT‐proBNP, HbA 1c , age, gender and duration of diabetes for all endpoints ( P < 0·001). NT‐proBNP at follow‐up was the best predictor for the remaining period ( P < 0·001, all endpoints). HbA 1c at baseline and follow‐up was predictive for all‐cause hospitalizations ( P = 0·005 both). In a third model that investigated the plasticity of both markers, changes in HbA 1c concentration had no predictive value, but a change of NT‐proBNP concentration was highly predictive ( P = 0·025 all‐cause mortality, P < 0·001 all other endpoints). Conclusions N‐terminal pro‐B‐type natriuretic peptide and HbA 1c concentrations significantly diverged over a 1‐year period. NT‐proBNP was the most potent predictor of outcome at baseline and follow‐up, and changes in NT‐proBNP concentrations were linked to an altered risk profile, unlike changes in HbA 1c levels.