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Use of the Burden of Diabetes Mellitus Score for Cardiovascular Disease Risk Assessment

      Highlights

      • There is currently no established variable to quantify hyperglycemia over long periods of time.
      • In type 2 diabetes, hemoglobin A1c levels and duration of disease are two of the strongest predictors of poor cardiovascular outcomes including myocardial infarction and all-cause mortality.
      • A diabetes burden score accounting for time prior to diabetes diagnosis, age at diagnosis, and aggregate HbA1c levels thereafter can have clinical utility for cardiovascular disease risk stratification.
      • A higher diabetes burden score was associated with significantly worse major adverse cardiovascular events as well as other poor outcomes including myocardial infarction and all-cause hospitalization giving evidence to the clinical utility of a measure of chronic hyperglycemia.
      • A validated diabetes burden score can be used to risk stratify patients for cardiovascular disease in both clinical and research settings.
      Uncontrolled type II diabetes mellitus (DM) using single point hemoglobin A1c levels has been associated with poor cardiovascular outcomes. However, methods to quantify the effect of uncontrolled DM over time have been inconsistent. To quantify hyperglycemia over time and assess its cardiovascular effects we developed and tested a DM burden score which accounts for time in years prior to DM diagnosis, diagnostic HbA1c, and aggregate HbA1c levels thereafter. A retrospective cohort study was performed with patients (n = 188) from a single academic center with type II DM and no prior cardiac disease history. Patient scores were calculated from diagnosis until the year 2015 and were grouped into low (<5.3%; n = 55), moderate (5.3% to 5.5%; n = 80), and high (>5.5%; n = 53) DM burden score cohorts. At 48 months, the cohort with high DM burden scores correlated with significantly worse major adverse cardiovascular events (hazard ratio [HR] 3.07, p = 0.012), myocardial infarction (HR 12.78, p = 0.015), coronary revascularization (HR 4.53, p = 0.019), cardiovascular hospitalizations (HR 4.20, p = 0.005), and all-cause hospitalizations (HR 2.57, p = 0.01). Cardiovascular and all-cause mortality showed significant difference between groups in log-rank testing. Also, a multivariate regression model showed DM burden score (p = 0.045) to be an independent predictor of major adverse cardiovascular events (HR 9.38, p = 0.045). In conclusion, this study provides evidence that DM control over time impacts cardiovascular outcomes.
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