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Original Research

A1C and Cardiovascular Outcomes in Type 2 Diabetes

A nested case-control study

  1. Danielle C. Colayco, PHARMD, MS1,
  2. Fang Niu, MS2,
  3. Jeffrey S. McCombs, PHD1 and
  4. T. Craig Cheetham, PHARMD, MS2
  1. 1University of Southern California School of Pharmacy, Department of Pharmaceutical Economics & Policy, Los Angeles, California;
  2. 2Kaiser Permanente, Pharmacy Analytical Services, Downey, California.
  1. Corresponding author: Danielle C. Colayco, colayco{at}usc.edu.
Diabetes Care 2011 Jan; 34(1): 77-83. https://doi.org/10.2337/dc10-1318
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Abstract

OBJECTIVE Type 2 diabetes is associated with increased cardiovascular risk. The role of aggressive glycemic control in preventing cardiovascular events is unclear. A nested case-control study design was used to evaluate the association between average A1C and cardiovascular outcomes.

RESEARCH DESIGN AND METHODS Adults with type 2 diabetes were identified among members of Kaiser Permanente Southern California. Type 2 diabetes was identified based on ICD-9 diagnosis codes and either A1C >7.5% or prescriptions for hypoglycemic agents. Case subjects were defined based on nonfatal myocardial infarction, nonfatal stroke, or death attributed to cardiovascular events during a 3-year window. Four type 2 diabetes control subjects were matched to each case subject based on age, sex, and index date for the corresponding case. A conditional logistic regression model was used to estimate the odds ratio of cardiovascular events and compare three patient groups based on average A1C measured in the preindex period (≤6, >6–8, >8%).

RESULTS A total of 44,628 control subjects were matched to 11,157 case subjects. Patients with an average A1C ≤6% were 20% more likely to experience a cardiovascular event than the group with an average A1C of >6–8% (P < 0.0001). Patients with an average A1C >8% experienced a 16% increase in the likelihood of a cardiovascular event (P < 0.0001). We found evidence of statistical interaction with A1C category and LDL level (P = 0.0002), use of cardiovascular medications (P = 0.02), and use of antipsychotics (P = 0.001).

CONCLUSIONS High-risk patients with type 2 diabetes who achieved mean A1C levels of ≤6% or failed to decrease their A1C to <8% are at increased risk for cardiovascular events.

Footnotes

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

  • Received July 10, 2010.
  • Accepted September 29, 2010.
  • © 2011 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Diabetes Care: 34 (1)

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January 2011, 34(1)
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A1C and Cardiovascular Outcomes in Type 2 Diabetes
Danielle C. Colayco, Fang Niu, Jeffrey S. McCombs, T. Craig Cheetham
Diabetes Care Jan 2011, 34 (1) 77-83; DOI: 10.2337/dc10-1318

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A1C and Cardiovascular Outcomes in Type 2 Diabetes
Danielle C. Colayco, Fang Niu, Jeffrey S. McCombs, T. Craig Cheetham
Diabetes Care Jan 2011, 34 (1) 77-83; DOI: 10.2337/dc10-1318
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