Inconvenient relationship of haemoglobin A1c level with endothelial function in type 2 diabetes in a cross-sectional study.

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  • Additional Information
    • Source:
      Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
    • Publication Information:
      Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
    • Subject Terms:
      Diabetes Mellitus, Type 2*/drug therapy; Cross-Sectional Studies ; Endothelium, Vascular ; Glycated Hemoglobin ; Humans ; Japan ; Vasodilation
    • Abstract:
      Objective: The aim of this study was to determine the relationship of haemoglobin A1c (HbA1c) level with flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation (NID) in patients with type 2 diabetes.
      Design: Cross-sectional study.
      Setting: 22 university hospitals and affiliated clinics in Japan.
      Participants: 1215 patients with type 2 diabetes including 349 patients not taking antidiabetic drugs.
      Measures: We evaluated FMD and HbA1c level. All patients were divided into four groups based on HbA1c level: <6.5%, 6.5%-6.9%, 7.0%-7.9% and ≥8.0%.
      Results: An inverted U-shaped pattern of association between HbA1c level and FMD was observed at the peak of HbA1c of about 7%. FMD was significantly smaller in the HbA1c <6.5% group than in the HbA1c 6.5%-6.9% group and HbA1c 7.0%-7.9% group (p<0.001 and p<0.001), and FMD values were similar in the HbA1c <6.5% group and HbA1c ≥8.0% group. There were no significant differences in NID values among the four groups. After adjustments for confounding factors, FMD was significantly smaller in the HbA1c <6.5% group than in the HbA1c 6.5%-6.9% and HbA1c 7.0%-7.9% group (p=0.002 and p=0.04). In patients not taking antidiabetic drugs, FMD was also significantly smaller in the HbA1c <6.5% group than in the HbA1c 6.5%-6.9% group and HbA1c 7.0%-7.9% group (p<0.001 and p=0.02), and there were no significant differences in NID values among the four groups.
      Conclusions: These findings suggest that there is an inverted U-shaped pattern of association between FMD and HbA1c and that a low HbA1c level of <6.5% is associated with endothelial dysfunction.
      Trial Registration Number: UMIN000012950, UMIN000012951, UMIN000012952 and UMIN000003409.
      Competing Interests: Competing interests: None declared.
      (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
    • References:
      N Engl J Med. 2010 Oct 7;363(15):1410-8. (PMID: 20925543)
      Pharmacol Ther. 2004 Apr;102(1):87-96. (PMID: 15056500)
      Diabetes Care. 1993 Feb;16(2):434-44. (PMID: 8432214)
      Cardiovasc Diabetol. 2014 Jul 30;13:110. (PMID: 25074318)
      Eur Heart J. 2006 Jul;27(13):1605-9. (PMID: 16762982)
      Int J Cardiol. 2018 Mar 1;254:284-290. (PMID: 29407110)
      Int J Cardiol. 2017 Aug 15;241:30-34. (PMID: 28341376)
      Heart. 2013 Dec;99(24):1837-42. (PMID: 24153417)
      Diabetes Care. 2018 Jan;41(Suppl 1):S13-S27. (PMID: 29222373)
      Diabetes Res Clin Pract. 1995 May;28(2):103-17. (PMID: 7587918)
      BMJ. 2000 Aug 12;321(7258):405-12. (PMID: 10938048)
      N Engl J Med. 2018 Aug 16;379(7):633-644. (PMID: 30110583)
      Diabetes Metab Res Rev. 2008 Jul-Aug;24(5):353-63. (PMID: 18461635)
      J Clin Hypertens (Greenwich). 2018 May;20(5):910-917. (PMID: 29729072)
      Am J Physiol. 1990 Jun;258(6 Pt 2):H1775-9. (PMID: 1972868)
      Circ J. 2009 Mar;73(3):411-8. (PMID: 19194043)
      Atherosclerosis. 2004 May;174(1):49-56. (PMID: 15135250)
      J Diabetes Complications. 2006 Nov-Dec;20(6):395-401. (PMID: 17070446)
      Am J Hypertens. 2002 Apr;15(4 Pt 1):302-9. (PMID: 11991214)
      Arterioscler Thromb Vasc Biol. 2011 Oct;31(10):2353-9. (PMID: 21737782)
      Chest. 2004 Mar;125(3):823-30. (PMID: 15006938)
      N Engl J Med. 2010 Jul 15;363(3):233-44. (PMID: 20587587)
      Hypertension. 1999 Jan;33(1 Pt 2):591-7. (PMID: 9931171)
      Diabetologia. 1996 Dec;39(12):1540-5. (PMID: 8960840)
      PLoS One. 2012;7(6):e38877. (PMID: 22719972)
      Int Heart J. 2012;53(3):170-5. (PMID: 22790685)
      Ann Intern Med. 2004 Sep 21;141(6):413-20. (PMID: 15381514)
      J Korean Med Sci. 2012 Nov;27(11):1364-70. (PMID: 23166419)
      N Engl J Med. 2008 Jun 12;358(24):2545-59. (PMID: 18539917)
      Nature. 2001 Dec 13;414(6865):813-20. (PMID: 11742414)
      Arch Endocrinol Metab. 2017 Dec;61(6):542-549. (PMID: 28724057)
      Arterioscler Thromb Vasc Biol. 2013 Jun;33(6):1401-8. (PMID: 23520168)
      Rev Diabet Stud. 2014 Summer;11(2):138-52. (PMID: 25396402)
      Circulation. 2003 Aug 5;108(5):530-5. (PMID: 12874192)
      Diabetes Care. 2017 Apr;40(4):453-460. (PMID: 28223299)
      Circulation. 2009 Aug 11;120(6):502-9. (PMID: 19635967)
      JAMA. 2001 May 16;285(19):2486-97. (PMID: 11368702)
      J Am Coll Cardiol. 1996 Mar 1;27(3):567-74. (PMID: 8606266)
      N Engl J Med. 2009 Jan 8;360(2):129-39. (PMID: 19092145)
      N Engl J Med. 2008 Jun 12;358(24):2560-72. (PMID: 18539916)
      J Am Coll Cardiol. 2016 Feb 2;67(4):456-458. (PMID: 26821636)
      Eur Heart J. 2013 Oct;34(40):3137-44. (PMID: 23999452)
    • Contributed Indexing:
      Keywords: cardiology; diabetes & endocrinology; general diabetes
    • Molecular Sequence:
      UMIN-CTR UMIN000012950; UMIN000012951; UMIN000012952; UMIN000003409
    • Accession Number:
      0 (Glycated Hemoglobin A)
    • Publication Date:
      Date Created: 20210610 Date Completed: 20210618 Latest Revision: 20221207
    • Publication Date:
      20231215
    • Accession Number:
      PMC8191618
    • Accession Number:
      10.1136/bmjopen-2020-045415
    • Accession Number:
      34108164