Tip 2 Diyabetli Hastalarda Makrovasküler Komplikasyonlar ile Hemoglobin Glikasyon İndeksi (HGİ) Arasındaki İlişkinin Değerlendirilmesi

Öz

Hemoglobin Glikasyon İndeksi (HGI), ortalama kan şekeri düzeylerinin ötesinde bireyler arası hemoglobin glikasyon farklılıklarını yansıtır ve tip 2 diyabetes mellitusta (T2DM) vasküler riskin daha doğru değerlendirilmesini sağlayabilir. Bu retrospektif kesitsel çalışmaya, Ocak–Aralık 2024 tarihleri arasında üçüncü basamak bir hastanenin dahiliye polikliniğinde izlenen 391 T2DM’li yetişkin hasta dahil edildi. Hastalar, koroner arter hastalığı, iskemik inme ve periferik arter hastalığı gibi makrovasküler komplikasyonların varlığına göre sınıflandırıldı. HGI, ölçülen HbA1c değeri ile açlık plazma glukozundan (FPG) tahmin edilen HbA1c arasındaki fark olarak hesaplandı (Tahmini HbA1c = 0.024 × FPG + 3.1). Makrovasküler komplikasyonu olan hastalarda HGI değerleri anlamlı olarak daha yüksekti (medyan (IQR): 1.68 (1.31–2.06) vs. 0.48 (0.11–1.14); p < 0.001). HGI’nin makrovasküler komplikasyonları öngörmedeki ROC eğrisi altındaki alanı 0.870 (95% GA: 0.833–0.908; p < 0.001) olup, 1.13 kesim değeri %87.6 duyarlılık ve %74.2 özgüllük sağladı. Çok değişkenli lojistik regresyon analizinde HGI (OR = 6.75, %95 GA: 4.25–10.71; p < 0.001), diyabet süresi ve idrar albümin/kreatinin oranı HbA1c düzeylerinden ve geleneksel kardiyovasküler risk faktörlerinden bağımsız olarak makrovasküler komplikasyonların bağımsız belirleyicileri olarak saptandı. Bu bulgular, yüksek HGI’nin makrovasküler komplikasyonlarla yakından ilişkili olduğunu göstermekte ve HGI’nin, HbA1c’yi tamamlayan, glikasyona bağlı vasküler stresin basit, düşük maliyetli ve klinik olarak anlamlı bir biyobelirteci olabileceğini düşündürmektedir.

Anahtar Kelimeler

• Tip 2 Diyabet
• Hemoglobin glikasyon indeksi
• Makrovasküler komplikasyonlar
• Kardiyovasküler risk
• Glikasyon değişkenliği

Evaluation of the Relationship Between Macrovascular Complications and Hemoglobin Glycation Index (HGI) in Patients with Type 2 Diabetes Mellitus

Öz

The Hemoglobin Glycation Index (HGI) reflects individual differences in hemoglobin glycation beyond mean blood glucose levels and may provide a more accurate assessment of vascular risk in type 2 diabetes mellitus (T2DM). This retrospective cross-sectional study included 391 adults with T2DM who were treated in the internal medicine outpatient clinic of a tertiary hospital between January and December 2024. Patients were categorized based on the presence of macrovascular complications, including coronary artery disease, ischemic stroke, and peripheral artery disease. HGI was calculated as the difference between measured HbA1c and the HbA1c predicted from fasting plasma glucose using the equation Predicted HbA1c = 0.024 × FPG + 3.1. Patients with macrovascular complications had significantly higher HGI values compared to those without (median (IQR): 1.68 (1.31–2.06) vs. 0.48 (0.11–1.14); p < 0.001). Receiver operating characteristic (ROC) curve analysis demonstrated a strong discriminative power of HGI for identifying macrovascular complications (AUC = 0.870, 95% CI: 0.833–0.908; p < 0.001), with an optimal cutoff value of 1.13 providing 87.6% sensitivity and 74.2% specificity. In multivariate logistic regression analysis, HGI (OR = 6.75, 95% CI: 4.25–10.71; p < 0.001), diabetes duration, and urinary albumin-to-creatinine ratio were independent predictors of macrovascular complications, regardless of HbA1c levels and traditional cardiovascular risk factors. These findings suggest that elevated HGI is closely associated with macrovascular complications and may serve as a simple and reliable marker of glycation-related vascular stress, complementing HbA1c in cardiovascular risk assessment for patients with T2DM.

Anahtar Kelimeler

• Type 2 Diabetes Mellitus
• Hemoglobin glycation index
• Macrovascular complications
• Cardiovascular risk
• Glycation variability

Kaynakça

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