Glycated hemoglobin A1c (HbA1c) variation or blood pressure (BP) variation was known to be an independent predictor of all-cause mortality in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the combined effect of HbA1c and systolic blood pressure (SBP) variation on all-cause mortality and if there was a gender difference in patients with T2DM. Patients with T2DM who had at least three HbA1c, SBP measurements within 12–24 months during 2001–2007 were included. Coefficient of variation (CV) was used to evaluate variation. The 75th percentile of HbA1c-CV and SBP-CV were set as a cutoff to define high and low variation. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazard models. A total of 2744 patients were included, of whom 769 died during the 11.7 observation years. The associated risk of all-cause mortality was 1.22 [1.01- 1.48], P = 0.044, for low HbA1c-CV & high SBP-CV; 1.28 [1.04–1.57], P = 0.020, for high HbA1c-CV & low SBP-CV; and 1.68 [1.31–2.17], P < 0.001, for high HbA1c-CV & high SBP-CV. The associated risk remained unchanged in either males or females older than 50 years old, although there is only numerically higher for high HbA1c-CV & low SBP-CV in females older than 50 years old. Both HbA1c and SBP variation were significant predictors of all-cause mortality in patients with T2DM. The combined effect was higher than either alone and no gender difference in patients older than 50 years old.

中文翻译：

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HbA1c 和收缩压变化可预测 2 型糖尿病患者的全因死亡率

已知糖化血红蛋白 A1c (HbA1c) 变异或血压 (BP) 变异是 2 型糖尿病 (T2DM) 患者全因死亡率的独立预测因子。本研究旨在探讨 HbA1c 和收缩压 (SBP) 变化对全因死亡率的综合影响，以及 T2DM 患者是否存在性别差异。纳入的 T2DM 患者在 2001 年至 2007 年期间的 12 至 24 个月内至少进行过 3 次 HbA1c、SBP 测量。变异系数（CV）用于评估变异。 HbA1c-CV 和 SBP-CV 的第 75 个百分位数被设置为定义高变异和低变异的截止值。使用 Cox 比例风险模型估计风险比 (HR) 和 95% 置信区间。总共纳入了 2744 名患者，其中 769 人在 11.7 个观察年内死亡。对于低 HbA1c-CV 和高 SBP-CV，全因死亡率的相关风险为 1.22 [1.01-1.48]，P = 0.044；对于高 HbA1c-CV 和低 SBP-CV，为 1.28 [1.04–1.57]，P = 0.020；对于高 HbA1c-CV 和高 SBP-CV，为 1.68 [1.31–2.17]，P < 0.001。 50 岁以上的男性或女性的相关风险保持不变，但 50 岁以上的女性中，高 HbA1c-CV 和低 SBP-CV 的相关风险仅在数值上较高。 HbA1c 和 SBP 变化都是 T2DM 患者全因死亡率的重要预测因素。综合效果高于单独使用任一方法，并且在 50 岁以上的患者中没有性别差异。