When Does Metabolic Memory Start? Insights From the Association of Medical Diabetologists Annals Initiative on Stringent HbA1c Targets

Early, intensive glycemic control in patients with type 2 diabetes (T2D) is associated with long-term benefits in cardiovascular disease (CVD) development. Evidence on benefits of achieving HbA1c targets close to normal values is scant. Individuals with newly diagnosed T2D, without CVD at baseline, were identified in an Italian clinical registry (n = 251,339). We adopted three definitions of early exposure periods (0–1, 0–2, and 0–3 years). Mean HbA1c was categorized into HbA1c <5.7%, 5.7–6.4%, 6.5–7.0%, 7.1–8.0%, and >8.0%. The outcome was the incidence of major cardiovascular events. After a mean follow-up of 4.6 ± 2.9 years, at multivariate Cox regression analysis, compared with mean HbA1c <5.7% during the first year after diagnosis, the increase in the risk of CVD was 24%, 42%, 49%, and 56% for patients with HbA1c of 5.7–6.4%, 6.5–7.0%, 7.1–8.0%, and >8.0%, respectively. The same trend was documented in all exposure periods. In conclusion, our data support that an early achievement of stringent targets of HbA1c <5.7% is worthy for CVD prevention.