Distinct trajectories of HbA_1c in newly diagnosed Type 2 diabetes from the DPV registry using a longitudinal group‐based modelling approach

Abstract

Aim To identify groups of heterogeneous HbA1c trajectories over time in newly diagnosed Type 2 diabetes. Methods The study comprised 6355 adults with newly diagnosed Type 2 diabetes (55% men, median age 62 years, baseline BMI 31 kg/m2) from the Diabetes Patienten Verlaufsdokumentation (DPV) prospective multicentre diabetes registry (Germany, Austria). Individuals were assessed during the first 5 years after diabetes diagnosis if they had ≥ 3 aggregated HbA1c measurements during follow‐up. Latent class growth modelling was used to determine distinct subgroups that followed similar longitudinal HbA1c patterns (SAS: Proc Traj). Multinomial logistic regression models were used to investigate which variables were associated with the respective HbA1c trajectory groups. Results Four distinct longitudinal HbA1c trajectory (glycaemic control) groups were found. The largest group (56% of participants) maintained stable good glycaemic control (HbA1c 42–45 mmol/mol). Twenty‐six percent maintained stable moderate glycaemic control (HbA1c 57–62 mmol/mol). A third group (12%) initially showed severe hyperglycaemia (HbA1c 97 mmol/mol) but reached good glycaemic control within 1 year. The smallest group (6%) showed stable poor glycaemic control (HbA1c 79–88 mmol/mol). Younger age at diabetes diagnosis, male sex, and higher BMI were associated with the stable moderate or poor glycaemic control groups. Insulin therapy was strongly associated with the highly improved glycaemic control group. Conclusions Four subgroups with distinct HbA1c trajectories were determined in newly diagnosed Type 2 diabetes using a group‐based modelling approach. Approximately one‐third of people with newly diagnosed Type 2 diabetes need either better medication adherence or earlier intensification of glucose‐lowering therapy.

Clinical Inertia and 2-Year Glycaemic Trajectories in Patients with Non-Newly Diagnosed Type 2 Diabetes Mellitus in Primary Care: A Retrospective Cohort Study

“…This proportion of people attaining good glycaemic control was much lower than that in previous studies of patients with newly diagnosed type 2 diabetes and indicated the difficulty of long-term glycaemic control. [3][4][5] Higher HbA 1c measurements at one year were associated with higher baseline HbA 1c , higher body weight and low treatment adherence. 16 Long diabetes duration was a risk factor for poor glycaemic control and increased the difficulty of reaching the HbA 1c target.…”

“…Patients would benefit from early good glycaemic control and be inclined to develop long-term stable, good HbA 1c trajectory thereafter. [3][4][5][6][7] Severe hyperglycaemia could be decreased to the level of good glycaemic control within one year and then kept stable for the subsequent four years. 4 In this present analysis, the change of the percentage of subjects having a HbA 1c ≥7.50% decreased.…”

“…[3][4][5][6][7] Severe hyperglycaemia could be decreased to the level of good glycaemic control within one year and then kept stable for the subsequent four years. 4 In this present analysis, the change of the percentage of subjects having a HbA 1c ≥7.50% decreased. Therefore, although baseline HbA 1c ≥7.5% was associated with a higher chance of belonging to the poorer glycaemic control groups, an HbA 1c change ≥−0.5% from baseline to visit 1, especially ≥−1.0%, was associated with a significantly lower chance of belonging to the poorer glycaemic control groups.…”

“…7 Unstable patterns identified included an increasing HbA 1c trend, a decreasing HbA 1c trend, stable moderate glycaemic control (eg HbA 1c of 7.4%-7.8%) or stable, poor control (eg extremely high but stable HbA 1c of 9.4%-10.2%). [4][5][6] All non-stable trajectories were associated with higher incidences of microvascular events. 3 In Rozing's report, an increase in HbA1c levels in the first year after diagnosis were associated with later diabetes-related morbidity and mortality, while an increase in HbA 1c levels during the first six years after diagnosis was associated with later (6-19 years) microvascular complications.…”

“…2 The most commonly identified patterns were good, stable glycaemic control found in 56%-82.5% of patients with newly diagnosed type 2 diabetes and in 53.2% of patients with diabetes of a duration ≥3 years. [3][4][5][6] Patients may benefit from early good glycaemic control and be inclined to develop a long-term good, stable HbA 1c trajectory thereafter. In McCoy's report, 95.5% of patients with stable, controlled diabetes kept a stable HbA 1c trajectory during the follow-up period.…”