{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T22:20:15Z","timestamp":1792016415219,"version":"4.4.0"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Glycaemic variability and body composition are emerging predictors of cardiovascular disease (CVD) in patients with Type 2 diabetes mellitus (T2DM); however, their combined impact remains unclear. We investigated the association among HbA1c variability, body composition parameters and cardiovascular outcomes in adults with T2DM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study analysed electronic health records from a university hospital (2011\u20132020), including 8224 adults (mean age 58.3\u2009years, 50.1% women) with T2DM and no history of CVD. HbA1c variability score (HVS) was defined as the percentage of successive measurements differing by \u2265\u20090.5% (5.5\u2009mmol\/mol). Body composition was assessed by bioimpedance analysis. The primary outcome was incident CVD (ischemic heart disease, heart failure, atrial fibrillation, stroke, myocardial infarction).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During median follow\u2010up of 4.0\u2009years, patients with high HVS (third tertile) showed significantly increased CVD risk compared to low HVS (first tertile) (adjusted hazard ratio [aHR] 1.70 [95% CI 1.13\u20132.40]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.010). HbA1c variability demonstrated superior cardiovascular risk prediction over fasting and postprandial glucose variability. Individuals with high HVS had significantly higher systolic blood pressure (122.72\u2009\u00b1\u200914.96 vs. 120.53\u2009\u00b1\u200914.52\u2009mmHg, <jats:italic>p<\/jats:italic>\u2009=\u20090.017), HbA1c (7.72%\u2009\u00b1\u20091.75% vs. 7.02%\u2009\u00b1\u20091.09%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and lower skeletal muscle mass (24.60\u2009\u00b1\u20095.73 vs. 25.85\u2009\u00b1\u20097.84\u2009kg, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Higher appendicular skeletal muscle mass was protective against CVD (aHR 0.75 [95% CI 0.63\u20130.88]), while increased total fat percentage elevated CVD risk (aHR 1.10 [95% CI 1.03\u20131.20]). HVS correlated positively with changes in total fat percentage (<jats:italic>\u03b2<\/jats:italic>\u2009=\u20090.439, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and negatively with changes in relative appendicular skeletal muscle mass (<jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u22120.258, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In multivariate analysis, significant contributors to increased CVD risk included high HVS (aHR 1.65, <jats:italic>p<\/jats:italic>\u2009=\u20090.011), elevated average HbA1c (aHR 1.09, <jats:italic>p<\/jats:italic>\u2009=\u20090.016) and age over 65\u2009years (aHR 1.61, <jats:italic>p<\/jats:italic>\u2009=\u20090.035).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>HbA1c variability and body composition independently predicted cardiovascular outcomes in patients with T2DM. Higher HbA1c variability increased CVD risk by 70%, while higher appendicular muscle mass reduced risk by 25%, and higher total fat percentage increased risk by 10%. Incorporating these parameters into risk stratification models could enhance cardiovascular risk prediction and guide preventive strategies for diabetes management.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.70028","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T08:18:31Z","timestamp":1753777111000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Dual Roles of HbA1c Variability and Body Composition for Cardiovascular Risk: A Cohort Study of 8224 Adults With Type 2 Diabetes Mellitus"],"prefix":"10.1002","volume":"16","author":[{"given":"Sunyoung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Kyung Hee University Medical Center Kyung Hee University College of Medicine  Seoul South Korea"},{"name":"Center for Digital Health, Medical Science Research Institute Kyung Hee University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyoung","family":"Hwang","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute Kyung Hee University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong\u00a0Keon","family":"Yon","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute Kyung Hee University College of Medicine  Seoul South Korea"},{"name":"Department of Pediatrics, Kyung Hee University Medical Center Kyung Hee University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunji","family":"Sang","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute Kyung Hee University College of Medicine  Seoul South Korea"},{"name":"Department of Endocrinology, Kyung Hee University Medical Center Kyung Hee University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selin","family":"Woo","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute Kyung Hee University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho\u00a0Geol","family":"Woo","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute Kyung Hee University College of Medicine  Seoul South Korea"},{"name":"Department of Neurology Kyung Hee University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunjung","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Medical Nutrition, Graduate School of East\u2010West Medical Science Kyung Hee University  Yongin South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jungha","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Kyung Hee University Medical Center Kyung Hee University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei\u2010Yuan","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Pharmacy, College of Medicine National Taiwan University  Taipei Taiwan"},{"name":"School of Pharmacy, College of Medicine National Taiwan University  Taipei Taiwan"},{"name":"Department of Pharmacy National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang\u2010Kung","family":"Chen","sequence":"additional","affiliation":[{"name":"Center for Healthy Longevity and Aging Sciences National Yang\u2010Ming Chiao Tung University  Taipei Taiwan"},{"name":"Center for Geriatrics and Gerontology Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"Taipei Municipal Gan\u2010Dau Hospital Managed by Taipei Veterans General Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0119-5818","authenticated-orcid":false,"given":"Sang\u00a0Youl","family":"Rhee","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute Kyung Hee University College of Medicine  Seoul South Korea"},{"name":"Department of Endocrinology, Kyung Hee University Medical Center Kyung Hee University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000395"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7258.405"},{"key":"e_1_2_8_4_1","first-page":"S20","article-title":"2. 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