Blood sugar variations in diabetes may increase risk of heart failure

Type 2 Diabetes Mellitus (T2DM) is associated with high morbidity and mortality due to Heart Failure (HF).

Researchers have found in a recent study that substantial changes and long-term variability in blood sugar and  HbA1c were each independently associated with risk of incident Heart Failure  among patients with T2DM.

Published in the journal "Diabetes Care" 2020, the study was carried out as the secondary analysis of the famous ACCORD trial. Researchers in the study evaluated the association between long-term change and variability in blood sugar with risk of heart failure (HF) among patients with T2DM.

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Patients in the glycaemic arm of the ACCORD trial were included in the study. Among the patients who enrolled, variability of HbA1c was assessed from stabilization following enrollment (8 months), to 3 years of follow up. During this period assessment was done by measuring average successive variability which is the absolute difference between successive values, coefficient of variation, and standard deviation. Participants with heart failure at baseline or within 3 years of enrollment were excluded from the study. Adjusted Cox models were used to evaluate the association of percent change from baseline to 3 years of follow-up and variability in HbA1c and blood sugar over the first 3 years of enrollment and subsequent risk of HF.

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The study included 8576 patients. The key points of the study were:

• Over a median follow-up of 6.4 years from the end of variability measurements at year 3(three), 388 patients had an incident HF hospitalization.

• Substantial changes in blood sugar and HbA1c were significantly associated with higher risk of heart failure.

• Greater long-term variability in HbA1c was significantly associated with higher risk of HF independent of baseline risk factors and interval changes in cardio-metabolic parameters.

• Consistent patterns of association were observed with use of alternative measures of blood sugar variability.

Thus, the researchers concluded that Substantial long-term changes and variability in blood sugar and HbA1c were independently associated with risk of HF among patients with T2DM. 

The current article is published in the journal Diabetes Care which is a part of the American Diabetes Association. 

To read the study, click the following link: https://doi.org/10.2337/dc19-2541