Association Between Hba1c Variability And Cardiovascular Events In Type 2 Diabetes Mellitus Patients

Abstract

Heterogeneity in glycated haemoglobin (HbA1c) has become a salient glycemic measure that exceeds mean HbA1c and can offer more insightful information on chronic glucose oscillations and their importance to the risk of macrovascular disease in patients with type 2 diabetes mellitus. Recent evidence suggests that a heightened variability of visit-to-visit HbA1c is closely related to the heightened risks of cardiovascular events, cardiovascular mortality, stroke, heart failure, limb ischemia, as well as composite major adverse cardiovascular events (MACE) in patients having type 2 diabetes mellitus (T2DM). The current meta-analysis is a synthesis of the results of 15 longitudinal cohort studies published between 2020 and 2025, including populations from Asia, Europe, and North America. Findings indicate that high HbA1c variability, whether in the form of standard deviation, coefficient of variation, not dependent on mean, average real variability, or maximum versus minimum score, always correlates with high macrovascular risk, regardless of classic risk factors. These results support the claim that the variability of HbA1c is a strong, independent predictor of cardiovascular risk and must be included in future mechanisms of cardiovascular risk-stratification and clinical management approaches to T2DM.