Evidence map›Paper›PMID 26518684›Full record

ArticleDiabetologia2016

Association of the average rate of change in HbA1c with severe adverse events: a longitudinal evaluation of audit data from the Bavarian Disease Management Program for patients with type 2 diabetes mellitus.

Florian C Bonke, Ewan Donnachie, Antonius Schneider, Michael Mehring

Registry-linked trialOpen access · bronzeAbstract read
PubMed Publisher
In one paragraph

Article in Diabetologia, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04730882 (Effect of Postprandial Hyperglycemia on Vasculature in Type 1 Diabetes and Healthy Adults), which is not on this map. Cited by 19 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 4 pooled it
1.8field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04730882 completednot on this mapstarted 2021, after this paper: background citation

Effect of Postprandial Hyperglycemia on Vasculature in Type 1 Diabetes and Healthy Adults

TypeobservationalSponsorUniversity of VirginiaRan2021 to 2024Enrolled36ConditionsType 1 Diabetes, Hyperglycemia, PostprandialArmsMixed Meal
3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 37 citations in OpenAlex.

  1. Pooled it
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  6. The Association of HbADiabetes therapy : research, treatment and education of diabetes and related disorders · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 1 country.

Florian C BonkeInstitute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, 81667, München, Germany.
Ewan DonnachieAssociation of Statutory Health Insurance Physicians of Bavaria, Munich, Germany.
Antonius SchneiderInstitute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, 81667, München, Germany.
Michael MehringInstitute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, 81667, München, Germany. michael.mehring@tum.de.
Klinikum rechts der Isar · DENational Association of Statutory Health Insurance Physicians · DETechnical University of Munich · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aims/hypothesisIn patients with type 2 diabetes mellitus, the effects of HbA1c variability on macrovascular events remain uncertain. The present investigation evaluates the association of HbA1c variability with non-fatal cardiovascular events, emergency admissions and episodes of severe hypoglycaemia in a cohort of patients newly started on insulin therapy.

methodsHbA1c variability was defined as the rate of change in values between observations. The medical records of 406,356 patients enrolled in a disease management programme for type 2 diabetes mellitus were analysed to identify a cohort of 13,777 patients with observed transition to insulin therapy. The cohort was observed for a period of at least 5 years. Cox regression models were applied to quantify the association of HbA1c variability with the events of interest.

resultsThe models reveal a significant non-linear association between HbA1c variability and the risk of experiencing myocardial infarction, stroke and hypoglycaemia. The lowest risk is seen with a variability of approximately 0.5% (5.5 mmol/mol) per quarter. Using Cox models to predict survival curves for the cohort with hypothetical HbA1c variability of 0.5% (5.5 mmol/mol) and 1.5% (16.4 mmol/mol) per quarter, the proportion experiencing myocardial infarction within 2 years increases significantly from 1% to 10%. The proportion experiencing stroke increases from 1% to 29%, hypoglycaemia from 2% to 24% and the risk of emergency admission from 2% to 21%. CONCLUSIONS/

interpretationIn patients newly started on insulin therapy, rapid and higher HbA1c variability is associated with an increased risk of myocardial infarction, stroke, severe hypoglycaemia and emergency admission.

Indexed as

AgedClinical AuditDiabetes ComplicationsDiabetes Mellitus, Type 2Disease ProgressionFemaleGermanyGlycated HemoglobinHumansHypoglycemiaInsulinMaleMiddle AgedPrognosisQuality of Health CareSeverity of Illness IndexGlycated HemoglobinInsulinDisease management programmeHbA1c variabilityHealth services researchSevere adverse eventsType 2 diabetes mellitus

Identifiers

PMID26518684
OpenAlexW1942539655

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.