Ten-year hemoglobin A1c trajectories and outcomes in type 2 diabetes mellitus: The Diabetes & Aging Study

Abstract

AIMS To classify trajectories of long term HbA1c values in patients after diagnosis of Type 2 diabetes and examine each trajectory's associations with subsequent microvascular and macrovascular events and mortality. METHODS Longitudinal follow-up of 28,016 patients newly diagnosed with Type 2 diabetes. Latent growth mixture modeling to identify ten-year HbA1c trajectories. Cox proportional hazards models to assess how HbA1c trajectories were associated with events (microvascular and macrovascular) and mortality. RESULTS We identified 5 HbA1c trajectories: “low stable” (82.5%), “moderate increasing late” (5.1%), “high decreasing early” (4.9%), “moderate peaking late” (4.1%) and “moderate peaking early” (3.3%). After adjusting for average HbA1c, compared to the low stable trajectory, all non-stable trajectories were associated with higher incidences of microvascular events (hazard ratio (HR) range, 1.28 (95% CI, 1.08-1.53) (high decreasing early) to 1.45 (95% CI, 1.20-1.75) (moderate peaking early). The high decreasing early trajectory was associated with an increased mortality risk (HR, 1.27 (95% CI, 1.03-1.58)). Trajectories were not associated with macrovascular events. CONCLUSIONS Non-stable HbA1c trajectories was associated with greater risk of microvascular events and mortality. These findings suggest a potential benefit of early diabetes detection, prioritizing good glycemic control, and maintaining control over time.

A risk score including body mass index, glycated haemoglobin and triglycerides predicts future glycaemic control in people with type 2 diabetes

“…To our knowledge, only two previous studies have examined latent glycaemic trajectories in patients with type 2 diabetes . Both studies identified four glycaemic trajectories, which had notable similarities to the trajectory patterns we observed in the present study.…”

“…When compared with white populations, other races tend to have higher HbA1c values, and their inclusion might have resulted in glycaemic control trajectories that differed in size and shape. One of the previous studies that examined latent glycaemic control trajectories included a mixed‐race population, with ~50% non‐white participants; however, as stated before, the identified trajectories in that study were similar to the trajectories in the present study.…”

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

“…Distinct HbA 1c trajectories in recently diagnosed Type 2 diabetes have only been reported in one previous study, based on data from a health maintenance organization in the USA (Kaiser Permanente Northern California), including 28 016 individuals over 10 years after Type 2 diabetes diagnosis . Five HbA 1c trajectories were found: ‘low stable’ (83%); ‘moderate increasing late’ (5%); ‘high decreasing early’ (5%); ‘moderate peaking late’ (4%); and ‘moderate peaking early’ (3%) .…”

Stacked classifiers for individualized prediction of glycemic control following initiation of metformin therapy in type 2 diabetes

“…Some studies have shown primary failure rates around 30% [14] and secondary failure rates as high as 42%, with mean failure rates of 12-17% per year [13]. Because of this high failure rate, and because of the positive effects of early treatment and restoration of glycemic control [15], it would be highly beneficial for a clinician to know at the time of treatment initiation whether a specific patient is likely to respond to metformin. If the a priori risk of near-term treatment failure is high, whether it be primary or secondary failure, developing and pursuing an alternative treatment pathway diagnosis may help facilitate effective long-term glycemic control and improve patient outcomes.…”