Longitudinal trends in HbA1c in diabetes: Stable means can hide meaningful long‐term changes

Rigalleau, Vincent; Benoit, Julie; Charret, Léa; Bertrand, C.; Foussard, Ninon; Blanco, Laurence; Alexandre, L.; Monlun, Marie; Mohammedi, Kamel

doi:10.1002/dmrr.3065

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…LCGA is a simplified reflection of the longitudinal HbA1c profiles in the population. However, the individual HbA1c trajectories may be much more diverse and complicated, and the model may not be able to capture all these different individual patterns . Lastly, this study was conducted in a single network of public primary care clinics in Singapore and we excluded a number of subjects due to lack of complete data for analysis.…”

Section: Discussionmentioning

confidence: 99%

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

Luo

Tan

Lim

et al. 2019

Diabetes Metabolism Res

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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.

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Section: Discussionmentioning

confidence: 99%

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

Luo

Tan

Lim

et al. 2019

Diabetes Metabolism Res

View full text Add to dashboard Cite

show abstract

“…Their mean (95% CI) HbA1c levels changed from 37.6 (36.5-38.6) mmol/mol at baseline to 37.9 (36.9-39.0) mmol/mol at 6 months, 38.5 (37.5-39.5) mmol/mol at 12 months, 38.8 (37.7-39.9) mmol/mol at 18 months, and 39.0 (37.5-40.3) mmol/mol at 24 months. Although individuals in this glycaemia group had a stable trajectory during the study period, some investigations suggested that a statistically 'stable' longitudinal trajectory of HbA1c underlies slow long-term progression to new-onset diabetes [41,42]. For example, a cohort study in individuals with type 2 diabetes showed that the rate of glycaemic deterioration during a 9-year follow-up was ?…”

Section: Discussionmentioning

confidence: 95%

Trajectories of glycaemia following acute pancreatitis: a prospective longitudinal cohort study with 24 months follow-up

et al. 2020

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Background New-onset diabetes is the most common sequela of acute pancreatitis (AP). Yet, prospective changes in glycaemia over time have never been investigated comprehensively in this study population. The primary aim was to determine the cumulative incidence of new-onset prediabetes and new-onset diabetes after AP over 24 months of follow-up in a prospective cohort study. The secondary aim was to identify trajectories of glycaemia during follow-up and their predictors at the time of hospitalisation. Methods Patients with a prospective diagnosis of AP and no diabetes based on the American Diabetes Association criteria were followed up every 6 months up to 24 months after hospital discharge. Incidence of new-onset prediabetes/diabetes over each follow-up period was calculated. Group-based trajectory modelling was used to identify common changes in glycaemia. Multinomial regression analyses were conducted to investigate the associations between a wide array of routinely available demographic, anthropometric, laboratory, imaging, and clinical factors and membership in the trajectory groups. Results A total of 152 patients without diabetes were followed up. The cumulative incidence of new-onset prediabetes and diabetes was 20% at 6 months after hospitalisation and 43% over 24 months of follow-up (p trend \ 0.001). Three discrete trajectories of glycaemia were identified: normal-stable glycaemia (32%), moderatestable glycaemia (60%), and high-increasing glycaemia (8%). Waist circumference was a significant predictor of moderate-stable glycaemia. None of the studied predictors were significantly associated with high-increasing glycaemia.Conclusions This first prospective cohort study of changes in glycaemia (determined at structured time points in unselected AP patients) showed that at least one out of five patients develops new-onset prediabetes or diabetes at 6 months of follow-up and more than four out of ten-in the first 2 years. Changes in glycaemia after AP follow three discrete trajectories. This may inform prevention or early detection of critical changes in blood glucose metabolism following an attack of AP and, hence, reduce the burden of new-onset diabetes after acute pancreatitis.

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Longitudinal trends in HbA1c in diabetes: Stable means can hide meaningful long‐term changes

Cited by 2 publications

References 13 publications

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

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

Trajectories of glycaemia following acute pancreatitis: a prospective longitudinal cohort study with 24 months follow-up

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