Association of diabetes treatment with long‐term glycemic patterns in patients with type 2 diabetes mellitus: A prospective cohort study

Abstract

Aim This study aimed to analyze diabetes treatment and treatment changes in association with long‐term glycemic patterns in an Asian population with diabetes. Materials and methods This was a prospective cohort study of 6218 patients with type 2 diabetes managed in public primary care clinics in Singapore. Clinical data from 2011 to 2016 were extracted from electronic medical records, including serial HbA1c measurements and dispensed antidiabetic medication records. Patterns of longitudinal HbA1c trajectories were identified using latent class growth analysis, and patients' annual treatment plans were compared between subgroups with different HbA1c patterns. Results We identified four distinct HbA1c patterns. Eighty‐one percent of patients were classified in the low‐stable group, where monotherapy and dual therapy with oral agents were the most common treatments. We also identified three groups with poorer control, with moderate‐stable (14%), moderate‐increase (3%), and high‐decrease (2%) HbA1c patterns. Insulin treatment was most prevalent in these groups, with 61% to 72% of subjects receiving insulin treatment in 2016. More than 60% of subjects in poorer control groups had experienced treatment intensification during follow‐up. Addition of multiple insulin injections was the most common intensification in moderate‐increase and high‐decrease groups. Conclusions Treatment reflected and was appropriate to the extent of dysglycemia in this population. A small group of patients had deteriorating glycemic control, in spite of being treated with multiple insulin injections, suggesting non‐response or non‐adherence to treatment. Further investigation is needed to identify reasons for the deteriorating control observed and design effective interventions for these patients.

Distinct trajectories of HbA1c in newly diagnosed Type 2 diabetes from the DPV registry using a longitudinal group‐based modelling approach

“…Finally, only a small group of people with Type 2 diabetes (3%) showed a deterioration in HbA 1c control despite intensive therapy (e.g. insulin) [21]. The present study provides several insights into factors associated with different HbA 1c trajectories.…”

“…Finally, only a small group of people with Type 2 diabetes (3%) showed a deterioration in HbA 1c control despite intensive therapy (e.g. insulin) .…”

Cohort profile: the Singapore diabetic cohort study

“…24 The role of diabetes treatment in shaping the HbA1c patterns has also been examined, with findings revealing that treatment by and large matched the extent of dysglycemia, and that HbA1c deterioration occurred in spite of treatment intensification and not due to a lack of intensification. 25…”

HbA1c trajectory and cardiovascular outcomes: an analysis of data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study

“…People with T2D are a heterogeneous population 13 and there may be considerable between-individual variations in responses to glucose-lowering treatment. 14 – 16 Moreover, the associations of between-individual variations in response to glycemic control with cardiovascular outcomes in patients with T2D are not yet clear. Using latent class analysis 17 may help identify patients with distinct HbA1c trajectories that are different from groupings using artificial HbA1c cut-off levels.…”