436-P: Stringent Glycemic Control and Long-Term Macrovascular Outcomes in People with Type 2 Diabetes in China—A Retrospective Study

Introduction & Objective: Safely achieving stringent glycemic control at hemoglobin A1c (HbA1c) ≤ 6.5% is recommended in some diabetes guidelines, and HbA1c < 5.7% is considered a normal level. We aim to examine the association between stringent glycemic control and long-term macrovascular outcomes using real world data in China.

Methods: Data were retrospectively extracted from a regional data platform (2006/1/1-2021/10/31) in Yinzhou, Ningbo, China. Adult T2D patients with ≥ 1 HbA1c record from 2007/01/01-2016/10/31 were included to ensure ≥ 5 years of follow-up. Index date was the first HbA1c occurred ≥ 90 days after the initial T2D diagnosis. Index and sustained stringent glycemic control were defined as achieving HbA1c at ≤ 6.5% or < 5.7% at index or every measurement during follow-up, respectively. Cox proportional hazard model was used to examine the association between stringent glycemic control and 3-point major adverse cardiovascular event (3P-MACE) occurred during follow-up, adjusting for demographic and clinical characteristics.

Results: A total of 7,049 patients (mean age 61.4±11.4 years, 3,751 [53.7%] female) were analyzed. Over a median follow-up of 6.7 years (interquartile range 5.5-7.9), 3P-MACE occurred in 1565 (22.2%) patients at an incidence rate of 3.4 per 100 person-years. Index and sustained stringent glycemic control were significantly associated with 3P-MACE risk reduction (all p<0.05). For index stringent glycemic control, the adjusted hazard ratio (aHR) was 0.88 [0.79-0.98] for HbA1c ≤ 6.5% and 0.84 [0.70-1.00] for HbA1c < 5.7%. For sustained stringent glycemic control, the aHR was 0.74 [0.63-0.86] for HbA1c ≤ 6.5% and 0.58 [0.42-0.79] for HbA1c < 5.7%.

Conclusion: Stringent glycemic control was associated with significant risk reduction in long-term macrovascular outcomes in Chinese people with T2D. Intensive diabetes therapies may have long-term benefits for cardio-cerebrovascular outcomes in T2D patients.