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Complications

The Hemoglobin Glycation Index Is Not an Independent Predictor of the Risk of Microvascular Complications in the Diabetes Control and Complications Trial

  1. John M. Lachin1,
  2. Saul Genuth2,
  3. David M. Nathan3 and
  4. Brandy N. Rutledge1
  1. 1The Biostatistics Center, George Washington University, Rockville, Maryland
  2. 2Case Western Reserve University, Cleveland, Ohio
  3. 3Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  1. Address correspondence and reprint requests to John M. Lachin, The Biostatistics Center, 6110 Executive Blvd., Rockville, MD 20852. E-mail: jml{at}biostat.bsc.gwu.edu
Diabetes 2007 Jul; 56(7): 1913-1921. https://doi.org/10.2337/db07-0028
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  • FIG. 1.
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    FIG. 1.

    Scatter plot of the A1C versus HGI for all visits of all DCCT subjects, with the estimated regression line; intercept 8.2, slope 1.08 A1C % increase per unit increase in the HGI, and correlation of 0.77.

  • FIG. 2.
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    FIG. 2.

    Scatter plots of the observed A1C versus the observed within-profile MBG at all visits during the DCCT. A: For all participants. B–D: For those participants in the high, moderate, and low HGI groups, respectively. The regression line shown in each panel was derived from the simple regression of A1C on the MBG from the population. The horizontal line is the mean A1C in each panel.

  • FIG. 3.
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    FIG. 3.

    Cumulative incidence of retinopathy progression within the high, moderate, and low HGI groups obtained from a Cox proportional hazards regression model adjusted for the effects of age, diabetes duration, sex, treatment group, cohort, and MBG as a time-dependent covariate. The adjusted relative risk (RR) for moderate versus low HGI and for high versus low HGI with P value and the overall 2-df Wald test, χ2, and P values are shown. A: Without adjustment for A1C. B: With adjustment for the A1C at eligibility and the time-dependent current updated mean A1C.

  • FIG. 4.
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    FIG. 4.

    Cumulative incidence of nephropathy progression (advanced microalbuminuria) within the high, moderate, and low HGI groups, obtained from a Cox proportional hazards regression model adjusted for the effects of age, diabetes duration, sex, treatment group, cohort, and MBG as a time-dependent covariate. The adjusted RR for moderate versus low HGI and for high versus low HGI with P value and the overall 2-df Wald test, χ2, and P values are shown. A: Without adjustment for A1C. B: With adjustment for the A1C at eligibility and the time-dependent current updated mean A1C.

  • FIG. 5.
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    FIG. 5.

    Cumulative incidence of retinopathy progression within the high, moderate, and low HGI groups for those subjects within the low MBG group, obtained from a Cox proportional hazards regression model adjusted for the effects of age, diabetes duration, sex, treatment group, cohort, and MBG as a time-dependent covariate. The adjusted RR for moderate versus low HGI and for high versus low HGI with P value and the overall 2-df Wald test, χ2, and P values are shown. A: Without adjustment for A1C. B: With adjustment for the A1C at eligibility and the time-dependent current updated mean A1C.

  • FIG. 6.
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    FIG. 6.

    Cumulative incidence of retinopathy progression within the high, moderate, and low HGI groups for those subjects within the high MBG group, obtained from a Cox proportional hazards regression model adjusted for the effects of age, diabetes duration, sex, treatment group, cohort, and MBG as a time-dependent covariate. The adjusted RR for moderate versus low HGI and for high versus low HGI with P value and the overall 2-df Wald test, χ2, and P values are shown. A: Without adjustment for A1C. B: With adjustment for the A1C at eligibility and the time-dependent current updated mean A1C.

Tables

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  • TABLE 1

    DCCT baseline characteristics by treatment group

    ConventionalIntensive
    n729710
    Cohort
        Secondary intervention377 ± 51.7348 ± 49.0
        Primary prevention352 ± 48.3362 ± 51.0
    Age (years)26.5 ± 7.127.1 ± 7.1
    Race (Caucasian)703 ± 96.4686 ± 96.6
    Sex (male)394 ± 54.0365 ± 51.4
    Duration of type 1 diabetes (years)5.7 ± 4.16.0 ± 4.2
    A1C at eligibility (%)9.05 ± 1.639.08 ± 1.59
    MBG at DCCT baseline (mmol/l)12.8 ± 4.413.0 ± 4.6
    • Data are n (%) and means ± SD. P > 0.10 for all comparisons.

  • TABLE 2

    MBG, HGI, and A1C among all visits for subjects classified by low, moderate, and high levels of the HGI

    HGI groupn (subjects)n (Obs)MBGHGIA1C
    Low (<−0.425)46711,33810.00 (3.75)−0.91 (0.78)7.25 (1.17)
    Moderate (−0.425 to 0.249)47011,35110.17 (3.99)−0.09 (0.75)7.85 (1.29)
    High (>0.25)50211,35012.20 (4.68)0.92 (1.12)9.34 (1.66)
    • Data are means (SD). Obs, quarterly visit values.

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The Hemoglobin Glycation Index Is Not an Independent Predictor of the Risk of Microvascular Complications in the Diabetes Control and Complications Trial
John M. Lachin, Saul Genuth, David M. Nathan, Brandy N. Rutledge
Diabetes Jul 2007, 56 (7) 1913-1921; DOI: 10.2337/db07-0028

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The Hemoglobin Glycation Index Is Not an Independent Predictor of the Risk of Microvascular Complications in the Diabetes Control and Complications Trial
John M. Lachin, Saul Genuth, David M. Nathan, Brandy N. Rutledge
Diabetes Jul 2007, 56 (7) 1913-1921; DOI: 10.2337/db07-0028
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