Although a so-called “J”- or “U”-shaped relationship between treatment-achieved HbA1c values and risk of coronary artery disease (CAD) has often been reported, it is not yet clarified whether the association is maintained across various treatment modalities including diet only (D) for macro/microvascular complications of diabetes. Thus, we investigated effects of treatment-achieved HbA1c on CAD events and treatment-required diabetic eye disease (TRDED) in 4 treatment subgroups: D, insulin (I), sulfonylurea (S) and antihyperglycemic agents other than glinides, S or I. We utilized a nationwide claims database of 14,633 patients with diabetes in Japan (mean age 50.3 y, HbA1c 7.2%). Cox regression examined CAD and TRDED risk over a 5.1 y follow-up. A significant linear trend in the association between HbA1c and CAD events was only seen in the D group. Significantly higher risks for CAD were observed in the I and S groups whose HbA1c was ≤7.0% or S compared to D group patients with HbA1c ≤7.0%. Conversely, risk for TRDED was strongly dependent on achieved HbA1c regardless of treatment modalities. However, risks of TRDED did not differ significantly between categories of ≤7.0% and 7.1-8.0% among S and I groups. These results implied the necessity of setting different target HbA1c goals according to treatment modalities for prevention of micro-/macrovascular complications.
M. Harada: None. K. Fujihara: None. T. Osawa: None. M. Yamamoto: None. M. Kaneko: None. Y. Matsubayashi: None. S. Matsunaga: None. T. Yamada: None. N. Yamanaka: None. H. Seida: None. S. Kodama: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..