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The true value of HbA1c as a predictor of diabetic complications: simulations of HbA1c variables.

Lind M, Odén A, Fahlén M, Eliasson B - PLoS ONE (2009)

Bottom Line: Continuous HbA1c curves for 10,000 hypothetical diabetes patients were simulated over an average of 7 years.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Uddevalla Hospital, Uddevalla, Sweden. lind.marcus@telia.com

ABSTRACT

Aim: The 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.

Method: Continuous 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.

Results: The 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.

Conclusions: The 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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Related in: MedlinePlus

Study model of the temporal relationship between HbA1c and diabetes complications.Relative contribution to the constructed variables at different periods after an HbA1c value was present. The time to maximal effect was A which was reached after a period of increase B and followed by a period of decrease C.
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pone-0004412-g003: Study model of the temporal relationship between HbA1c and diabetes complications.Relative contribution to the constructed variables at different periods after an HbA1c value was present. The time to maximal effect was A which was reached after a period of increase B and followed by a period of decrease C.

Mentions: The function g comprised three parameters: 1) time to maximum effect on the development of diabetic complications, 2) the rate of increase in the effect until the maximum is reached, and 3) the rate of decrease in the effect after the maximum (Figure 3).


The true value of HbA1c as a predictor of diabetic complications: simulations of HbA1c variables.

Lind M, Odén A, Fahlén M, Eliasson B - PLoS ONE (2009)

Study model of the temporal relationship between HbA1c and diabetes complications.Relative contribution to the constructed variables at different periods after an HbA1c value was present. The time to maximal effect was A which was reached after a period of increase B and followed by a period of decrease C.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2636883&req=5

pone-0004412-g003: Study model of the temporal relationship between HbA1c and diabetes complications.Relative contribution to the constructed variables at different periods after an HbA1c value was present. The time to maximal effect was A which was reached after a period of increase B and followed by a period of decrease C.
Mentions: The function g comprised three parameters: 1) time to maximum effect on the development of diabetic complications, 2) the rate of increase in the effect until the maximum is reached, and 3) the rate of decrease in the effect after the maximum (Figure 3).

Bottom Line: Continuous HbA1c curves for 10,000 hypothetical diabetes patients were simulated over an average of 7 years.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Uddevalla Hospital, Uddevalla, Sweden. lind.marcus@telia.com

ABSTRACT

Aim: The 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.

Method: Continuous 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.

Results: The 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.

Conclusions: The 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.

Show MeSH
Related in: MedlinePlus