The Future of HbA1c in Risk Prediction, Prevention and Management of Cardiovascular Events in Diabetes Mellitus: What are the Likely New Treatment Targets? A Perspective

Authors : Basil Chukwuma Ezeokpo; Chidiebere V. Ugwueze; Bede I. Nnolim; Emmanuel A. Agim; Nnamdi C. Anikpo; Kenechukwu E. Onyekachi

Volume/Issue : Volume 5 - 2020, Issue 11 - November

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Haemoglobin A1c (HbA1c) offers a retrospective analysis of patient’s glucose excursions and is used in determining cardiovascular disease risks in diabetes mellitus patients. The availability of drugs of the class, Sodium-Glucose Co Transporter-2 inhibitors (SGLT), and Glucagon-like –peptide -1 (GLP-1) receptor agonists offer a proactive option to the management of cardiovascular disease complications in diabetes mellitus patients, despite failure to achieve HbA1c levels. The lowest level of HbA1c associated with increased cardiovascular risks varies between the young and the old, and between races, as exemplified in the risk of diabetic retinopathy. The Metabolic Memory has also introduced the need to control hyperglycaemia as early as in the pre-diabetes stage, and also to address the factors that maintain the vicious circle of metabolic dysfunction. Pre-diabetes carries cardiovascular risk, achievement and maintenance of HbA1c goals among diabetes patients are poor, thus emphasising the cardiovascular disease risks. This is pertinent in regions where the burden of diabetes mellitus is high, and frequent HbA1c monitoring cannot be achieved. The different HbA1c indices have not been shown to prevent stroke, diabetic foot ulcer syndrome and diabetic retinopathy, which would soon become new targets as we achieve greater reduction in the other cardiovascular disease complications. We here offer a new perspective for reasons to start/initiate treatments with lifestyle modification, Metformin and GLP-1 or SGLT therapy.

Keywords : Diabetes Mellitus, HbA1c, HbA1c Variability, Cardiovascular Disease Risk, Metabolic Memory.


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31 - August - 2022

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