1
|
Wibaek R, Ibfelt EH, Andersen GS, Hulman A, Dabelea D, Jørgensen ME, Svensson J, Vistisen D, Rønn PF. Heterogeneity in glycaemic control in children and adolescents with type 1 diabetes: A latent class trajectory analysis of Danish nationwide data. Diabet Med 2024; 41:e15275. [PMID: 38157300 DOI: 10.1111/dme.15275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
AIMS Suboptimal glycaemic control in children and adolescents with type 1 diabetes is prevalent and associated with increased risk of diabetes-related complications and mortality later in life. First, we aimed to identify distinct glycated haemoglobin (HbA1c) trajectories in children and adolescents (2-19 years) with type 1 diabetes. Second, we examined their associations with clinical and socio-demographic factors. METHODS Data were obtained from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) comprising all Danish children and adolescents diagnosed with type 1 diabetes from 1996 to 2019. Subgroups of distinct mean trajectories of HbA1c were identified using data-driven latent class trajectory modelling. RESULTS A total of 5889 children (47% female) had HbA1c measured a median of 6 times (interquartile range 3-8) and contributing to 36,504 measurements. We identified four mean HbA1c trajectories, referred to as 'Stable but elevated HbA1c' (83%), 'Increasing HbA1c' (5%), 'Late HbA1c peak' (7%), and 'Early HbA1c peak' (5%). Compared to the 'Stable but elevated HbA1c' group, the three other groups presented rapidly deteriorating glycaemic control during late childhood or adolescence, had higher HbA1c at study entry, and included fewer pump users, higher frequency of inadequate blood glucose monitoring, more severe hypoglycaemic events, lower proportions with Danish origin, and worse educational status of parents. The groups also represented significant differences by healthcare region. CONCLUSIONS Children and adolescents with type 1 diabetes experience heterogenous trajectories with different timings and magnitudes of the deterioration of HbA1c levels, although the majority follow on average a stable, yet elevated HbA1c trajectory. The causes and long-term health implications of these heterogenous trajectories need to be addressed.
Collapse
Affiliation(s)
- Rasmus Wibaek
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Else H Ibfelt
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Gregers S Andersen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marit E Jørgensen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Jannet Svensson
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Dorte Vistisen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Pernille Falberg Rønn
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| |
Collapse
|
2
|
Davis TME, Davis W. The relationship between glycated haemoglobin and blood glucose-lowering treatment trajectories in type 2 diabetes: The Fremantle Diabetes Study Phase II. Diabetes Obes Metab 2024; 26:283-292. [PMID: 37795655 DOI: 10.1111/dom.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
AIMS To examine the relationships between glycaemia and treatment complexity over 6 years in well-characterized community-based people with type 2 diabetes. MATERIALS AND METHODS Fremantle Diabetes Study Phase II participants who had type 2 diabetes with glycated haemoglobin (HbA1c) and blood glucose-lowering therapy (BGLT) data over 6 years were included. Group-based multi-trajectory modelling identified combined HbA1c/BGLT trajectory subgroups for diabetes durations of ≤1.0 year (Group 1; n = 160), >1.0 to 10.0 years (Group 2; n = 382;) and >10.0 years (Group 3; n = 357). Multinomial regression was used to identify baseline associates of subgroup membership. RESULTS The optimum numbers of trajectory subgroups were three in Group 1 (low, medium, high) and four in Groups 2 and 3 (low, low/high medium, high). Each low trajectory subgroup maintained a mean HbA1c concentration of <53 mmol/mol (<7.0%) on lifestyle measures, or monotherapy (Group 3). All five medium subgroups had stable HbA1c trajectories at <58 mmol/mol (<7.5%) but required increasing oral BGLT, or insulin (Group 3, high medium). The Group 1 high subgroup showed a falling then increasing HbA1c with steady progression to insulin. The high subgroups in Groups 2 and 3 showed stable HbA1c profiles at means of approximately 64 mmol/mol (8.0%) and 86 mmol/L (10.0%), respectively, on insulin. Non-Anglo Celt ethnicity, central obesity and hypertriglyceridaemia were strongly associated with Group 1 high subgroup membership. Younger age at diagnosis and central obesity were independent associates of the most adverse HbA1c trajectories in Groups 2 and 3. CONCLUSIONS These data demonstrate diabetes duration-dependent heterogeneity in glycaemic and treatment profiles and related clinical and laboratory variables, which have implications for management.
Collapse
Affiliation(s)
- Timothy M E Davis
- University of Western Australia, Medical School, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Wendy Davis
- University of Western Australia, Medical School, Fremantle Hospital, Fremantle, Western Australia, Australia
| |
Collapse
|
3
|
Halalau A, Roy S, Hegde A, Khanal S, Langnas E, Raja M, Homayouni R. Risk factors associated with glycated hemoglobin A1c trajectories progressing to type 2 diabetes. Ann Med 2023; 55:371-378. [PMID: 36621941 PMCID: PMC9833406 DOI: 10.1080/07853890.2022.2164347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The notion of prediabetes, defined by the ADA as glycated hemoglobin A1c (HbA1c) of 5.7-6.4%, implies increased vascular inflammatory and immunologic processes and higher risk for developing diabetes mellitus and major cardiovascular events. We aimed to determine the risk factors associated with rapid progression of normal and prediabetes patients to type 2 diabetes mellitus (T2DM). METHODS Retrospective cohort study in a single 8-hospital health system in southeast Michigan, between 2006 and 2020. All patients with HbA1c <6.5% at baseline and at least 2 other HbA1c measurements were clustered in five trajectories encompassing more than 95% of the study population. Multivariate linear regression analysis was performed to examine the association of demographic and comorbidities with HbA1c trajectories progressing to diabetes. RESULTS A total of 5,347 prediabetic patients were clustered based on their HbA1c progression (C1: 4,853, C2: 253, C66: 102, C12: 85, C68: 54). The largest cluster (C1) had a baseline median HbA1c value of 6.0% and exhibited stable HbA1c levels in prediabetic range across all subsequent years. The smallest cluster (C68) had the lowest median baseline HbA1c value and also remained stable across subsequent years. The proportion of normal HbA1c in each of the pre-diabetic trajectories ranged from 0 to 12.7%, whereas 81.5% of the reference cluster (C68) were normal HbA1c at baseline. The C2 (steady rising) trajectory was significantly associated with BMI (adj OR 1.10, 95%CI 1.03-1.17), and family history of DM (adj OR 2.75, 95%CI 1.32-5.74). With respect to the late rising trajectories, baseline BMI was significantly associated with both C66 and C12 trajectory (adj OR 1.10, 95%CI 1.03-1.18) and (adj OR 1.13, 95%CI 1.05-1.23) respectively, whereas, the C12 trajectory was also significantly associated with age (adj OR 1.62, 95%CI 1.04-2.53) and history of MACE (adj OR 3.20, 95%CI 1.14-8.93). CONCLUSIONS We suggest that perhaps a more aggressive preventative approach should be considered in patients with a family history of T2DM who have high BMI and year-to-year increase in HbA1c, whether they have normal hemoglobin A1c or they have prediabetes.KEY MESSAGESProgression to diabetes from normal or prediabetic hemoglobin A1c within four years is associated with baseline BMI.A steady rise in HbA1c during a four-year period is associated with age and family history of T2DM, whereas age and personal history of MACE are associated with a rapid rise in HbA1c.A more aggressive preventative approach should be considered in patients with a family history of T2DM who have high BMI and year-to-year increase in HbA1c.
Collapse
Affiliation(s)
- Alexandra Halalau
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Sujoy Roy
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Arpitha Hegde
- Department of Electrical and Computer Engineering, Oakland University, Rochester, MI, USA
| | - Sumesh Khanal
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Emily Langnas
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Maidah Raja
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Ramin Homayouni
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| |
Collapse
|
4
|
McCoy RG, Faust L, Heien HC, Patel S, Caffo B, Ngufor C. Longitudinal trajectories of glycemic control among U.S. Adults with newly diagnosed diabetes. Diabetes Res Clin Pract 2023; 205:110989. [PMID: 37918637 PMCID: PMC10842883 DOI: 10.1016/j.diabres.2023.110989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/27/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023]
Abstract
AIMS To identify longitudinal trajectories of glycemic control among adults with newly diagnosed diabetes, overall and by diabetes type. METHODS We analyzed claims data from OptumLabs® Data Warehouse for 119,952 adults newly diagnosed diabetes between 2005 and 2018. We applied a novel Mixed Effects Machine Learning model to identify longitudinal trajectories of hemoglobin A1c (HbA1c) over 3 years of follow-up and used multinomial regression to characterize factors associated with each trajectory. RESULTS The study population was comprised of 119,952 adults with newly diagnosed diabetes, including 696 (0.58%) with type 1 diabetes. Among patients with type 1 diabetes, 52.6% were diagnosed at very high HbA1c, partially improved, but never achieved control; 32.5% were diagnosed at low HbA1c and deteriorated over time; and 14.9% had stable low HbA1c. Among patients with type 2 diabetes, 67.7% had stable low HbA1c, 14.4% were diagnosed at very high HbA1c, partially improved, but never achieved control; 10.0% were diagnosed at moderately high HbA1c and deteriorated over time; and 4.9% were diagnosed at moderately high HbA1c and improved over time. CONCLUSIONS Claims data identified distinct longitudinal trajectories of HbA1c after diabetes diagnosis, which can be used to anticipate challenges and individualize care plans to improve glycemic control.
Collapse
Affiliation(s)
- Rozalina G McCoy
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; University of Maryland Institute for Health Computing, Bethesda, MD, United States; OptumLabs, Eden Prairie, MN, United States; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States.
| | - Louis Faust
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States
| | - Herbert C Heien
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States
| | - Shrinath Patel
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States
| | - Brian Caffo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Che Ngufor
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States; Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
5
|
Lin Htun H, Lian W, Pin Phua H, Yidong Lim M, Peng Lim Quek T, Ek Kwang Chew Conceptualisation D, Lim WY. Glycated haemoglobin trajectories and one-year risk of potentially avoidable hospitalisations among adult type 2 diabetes patients seeking care at specialist outpatient clinics of a tertiary hospital: a cohort study. Diabetes Res Clin Pract 2023:110737. [PMID: 37285967 DOI: 10.1016/j.diabres.2023.110737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
AIM To evaluate the association between trajectories of glycated haemoglobin (HbA1c) and potentially avoidable hospitalisations (PAH). METHODS We performed a cohort study in a tertiary hospital in Singapore among adult type 2 diabetes patients with ≥3HbA1c tests over two years. Then, we followed up for one year after the last HbA1c reading. Glycaemic control was analysed by (1)HbA1c trajectories through group-based trajectory modelling, and (2)mean HbA1c. PAH was defined using the Agency of Healthcare Research and Quality criteria, categorising as overall, acute, chronic, diabetes-composites. RESULTS A total of 14923 patients (mean age:62.9±12.8 years;55.2% men)were included. Four HbA1c trajectories were observed; low-stable(n=9854,66.0%), moderate-stable(n=3125,20.9%), high-decrease(n=1017,6.8%) and high-persistent(n=927,6.2%). Compared to the low-stable trajectory, one-year risk ratio(RR) and 95%CI, respectively for moderate-stable, high-decrease and high-persistent trajectories were as follows:(1)overall PAH:1.15(1.00-1.31),1.53(1.31-1.80),1.96(1.58-2.43);(2)diabetes PAH:1.30(1.04-1.64),1.98(1.55-2.53),2.24(1.59-3.15);(3)acute PAH:1.14(0.90-1.44),1.29(0.95-1.77),1.75(1.17-2.62); and (4)chronic PAH:1.21(1.02-1.43),1.62(1.34-1.97),2.14(1.67-2.75). Mean HbA1c was significantly associated with overall and chronic-composites of PAH whilst evidence of a non-linear relationship with diabetes-composite of PAH was noted. CONCLUSION Patients with high-decrease trajectory had a risk lower than those with persistently-high HbA1c, highlighting that a greater risk of hospitalisation conferred by poor glycaemic control is potentially reversible. Determining HbA1c trajectories could help to identify the high-risk individuals for targeted and intensive management to improve care and reduce hospitalisations.
Collapse
Affiliation(s)
- Htet Lin Htun
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Weixiang Lian
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Hwee Pin Phua
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Moses Yidong Lim
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | | | | | - Wei-Yen Lim
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore.
| |
Collapse
|
6
|
Huang J, Chan SC, Ko S, Tong E, Cheung CSK, Wong WN, Cheung NT, Wong MCS. Associations between adoption of eHealth management module and optimal control of HbA1c in diabetes patients. NPJ Digit Med 2023; 6:67. [PMID: 37055503 PMCID: PMC10101956 DOI: 10.1038/s41746-023-00807-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
In January 2021, the eHealth App was launched in Hong Kong by the Hong Kong government to support the Electronic Health Record Sharing System (eHRSS). A Health Management Module in the eHealth App introduced new functions to record blood pressure, blood sugar, and heart rate, and downloading and sharing records. This study aims to compare the level of glycaemic control between users of the eHealth App and non-users. Type 2 diabetes patients who have joined the eHRSS with existing haemoglobin A1c (HbA1c) level records are recruited. Correlations between predictors and optimal HbA1c control (<7%) are examined using logistic regression analyses. A total of 109,823 participants are included, with 76,356 non-users of eHealth App, 31,723 users of eHealth App, and 1744 users of the eHealth Management Module together with the App. We collect HbA1c values from Jan 2021 to May 2022, and they are 6 months after the use of the App on average. Users of the eHealth Management Module are found to have more optimal HbA1c levels across all subgroups, with the strongest effect observed in younger females (aOR = 1.66, 95% CI = 1.27-2.17). eHealth App usage is also positively associated with optimal HbA1c levels, particularly amongst younger females (aOR = 1.17, 95% CI = 1.08-1.26). Overall, users of eHealth App and eHealth Management Module demonstrate more optimal HbA1c levels when compared with non-users, particularly among younger adults and females. These findings support its potential adoption in diabetes patients. Future studies should examine the impact of eHealth interventions on other clinical targets and diabetes complications.
Collapse
Affiliation(s)
- Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sze Chai Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Samantha Ko
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ellen Tong
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong SAR, China
| | - Clement S K Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong SAR, China
| | - Wing Nam Wong
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong SAR, China
| | - Ngai Tseung Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong SAR, China
| | - Martin C S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
- Centre for Health Education and Health Promotion, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
- School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- School of Public Health, Peking University, Beijing, China.
| |
Collapse
|
7
|
Chen J, Fan L, Maughn K, Rey GG, Liu Y, Nelson DR, Hood RC. Trajectory of glycated haemoglobin over time, using real-world data, in type 2 diabetes patients with obesity on a U-100 basal-bolus insulin regimen. Diabetes Obes Metab 2023; 25:1677-1687. [PMID: 36799018 DOI: 10.1111/dom.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
AIMS To identify patient clusters with poor glucose control among type 2 diabetes mellitus (T2DM) patients with obesity who are receiving basal-bolus insulin and to identify the potential therapeutic inertia factors associated with poor control. METHODS Glycated haemoglobin (HbA1c) trajectories across a 3-year period were structured at 6-month intervals for a retrospective cohort of T2DM patients with obesity on basal-bolus insulin from the Veterans' Health Administration database. Based on each patient's longitudinal HbA1c features, an unsupervised clustering procedure was used to determine the numbers of clusters and associated trajectory patterns. Multinomial logistic regression was used to examine the association between HbA1c trajectory clusters and patient characteristics/treatment patterns. RESULTS A total of 51 273 patients were included, of whom 11.2% were in a subgroup with persistent missingness of HbA1c values. For those with sufficient HbA1c observations, cluster analysis indicated six distinct HbA1c trajectories: stable low (35.8%); stable high (20.8%); descending low (10.5%); ascending low (10.2%); descending high (5.7%); and ascending high (5.7%). Being of Black ethnicity, not initiating noninsulin antihyperglycaemic agents (sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists or thiazolidinediones) or concentrated insulin, low adherence (measured by proportion of days covered), and reduced insulin prescription refills were factors associated with poorer HbA1c clusters; similar factors were associated with persistent HbA1c missingness. CONCLUSION The present study found the potential for therapeutic inertia among a significant proportion of T2DM patients with obesity on basal-bolus insulin. Subgrouping T2DM patients based on HbA1c missingness and HbA1c trajectories can inform disease management strategies.
Collapse
Affiliation(s)
- Jieling Chen
- Value, Evidence, and Outcomes | Real World Analytics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ludi Fan
- Value, Evidence, and Outcomes | Real World Analytics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Keisha Maughn
- Real World Evidence, STATinMED Research, Plano, Texas, USA
| | - Gabriel G Rey
- Real World Evidence, STATinMED Research, Plano, Texas, USA
| | - Yi Liu
- Real World Evidence, STATinMED Research, Plano, Texas, USA
| | - David R Nelson
- Value, Evidence, and Outcomes | Real World Analytics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Robert C Hood
- Endocrine Clinic of Southeast Texas, Beaumont, Texas, USA
| |
Collapse
|
8
|
Tee C, Xu H, Fu X, Cui D, Jafar TH, Bee YM. Longitudinal HbA1c trajectory modelling reveals the association of HbA1c and risk of hospitalization for heart failure for patients with type 2 diabetes mellitus. PLoS One 2023; 18:e0275610. [PMID: 36662791 PMCID: PMC9858041 DOI: 10.1371/journal.pone.0275610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 09/20/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Inconsistent conclusions in past studies on the association between poor glycaemic control and the risk of hospitalization for heart failure (HHF) have been reported largely due to the analysis of non-trajectory-based HbA1c values. Trajectory analysis can incorporate the effects of HbA1c variability across time, which may better elucidate its association with macrovascular complications. Furthermore, studies analysing the relationship between HbA1c trajectories from diabetes diagnosis and the occurrence of HHF are scarce. METHODS This is a prospective cohort study of the SingHealth Diabetes Registry (SDR). 17,389 patients diagnosed with type 2 diabetes mellitus (T2DM) from 2013 to 2016 with clinical records extending to the end of 2019 were included in the latent class growth analysis to extract longitudinal HbA1c trajectories. Association between HbA1c trajectories and risk of first known HHF is quantified with the Cox Proportional Hazards (PH) model. RESULTS 5 distinct HbA1c trajectories were identified as 1. low stable (36.1%), 2. elevated stable (40.4%), 3. high decreasing (3.5%), 4. high with a sharp decline (10.8%), and 5. moderate decreasing (9.2%) over the study period of 7 years. Poorly controlled HbA1c trajectories (Classes 3, 4, and 5) are associated with a higher risk of HHF. Using the diabetes diagnosis time instead of a commonly used pre-defined study start time or time from recruitment has an impact on HbA1c clustering results. CONCLUSIONS Findings suggest that tracking the evolution of HbA1c with time has its importance in assessing the HHF risk of T2DM patients, and T2DM diagnosis time as a baseline is strongly recommended in HbA1c trajectory modelling. To the authors' knowledge, this is the first study to identify an association between HbA1c trajectories and HHF occurrence from diabetes diagnosis time.
Collapse
Affiliation(s)
- Clarence Tee
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
| | - Haiyan Xu
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
| | - Xiuju Fu
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
| | - Di Cui
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
- Department of Advanced Design and Systmes Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Tazeen H. Jafar
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
9
|
Wong R, Vaddavalli R, Hall MA, Patel MV, Bramante CT, Casarighi E, Johnson SG, Lingam V, Miller JD, Reusch J, Saltz M, Stürmer T, Tronieri JS, Wilkins KJ, Buse JB, Saltz J, Huling JD, Moffitt R. Effect of SARS-CoV-2 Infection and Infection Severity on Longer-Term Glycemic Control and Weight in People With Type 2 Diabetes. Diabetes Care 2022; 45:2709-2717. [PMID: 36098660 PMCID: PMC9679257 DOI: 10.2337/dc22-0730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/16/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severity of infection with longer-term glycemic control and weight in people with type 2 diabetes (T2D) in the U.S. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study using longitudinal electronic health record data of patients with SARS-CoV-2 infection from the National COVID Cohort Collaborative (N3C). Patients were ≥18 years old with an ICD-10 diagnosis of T2D and at least one HbA1c and weight measurement prior to and after an index date of their first coronavirus disease 2019 (COVID-19) diagnosis or negative SARS-CoV-2 test. We used propensity scores to identify a matched cohort balanced on demographic characteristics, comorbidities, and medications used to treat diabetes. The primary outcome was the postindex average HbA1c and postindex average weight over a 1 year time period beginning 90 days after the index date among patients who did and did not have SARS-CoV-2 infection. Secondary outcomes were postindex average HbA1c and weight in patients who required hospitalization or mechanical ventilation. RESULTS There was no significant difference in the postindex average HbA1c or weight in patients who had SARS-CoV-2 infection compared with control subjects. Mechanical ventilation was associated with a decrease in average HbA1c after COVID-19. CONCLUSIONS In a multicenter cohort of patients in the U.S. with preexisting T2D, there was no significant change in longer-term average HbA1c or weight among patients who had COVID-19. Mechanical ventilation was associated with a decrease in HbA1c after COVID-19.
Collapse
Affiliation(s)
- Rachel Wong
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Rohith Vaddavalli
- Department of Computer Science, Stony Brook University, Stony Brook, NY
| | - Margaret A. Hall
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Monil V. Patel
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Carolyn T. Bramante
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Elena Casarighi
- AnacletoLab, Department of Computer Science “Giovanni degli Antoni,” Università degli Studi di Milano, Milan, Italy
- CINI, Infolife National Laboratory, Roma, Italy
| | - Steven G. Johnson
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN
| | - Veena Lingam
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Joshua D. Miller
- Division of Endocrinology and Metabolism, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Jane Reusch
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mary Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
| | - Jena S. Tronieri
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kenneth J. Wilkins
- Office of the Director, Biostatistics Program/Office of Clinical Research Support, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John B. Buse
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Jared D. Huling
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Richard Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| |
Collapse
|
10
|
Ibfelt EH, Wibaek R, Vistisen D, Andersen GS, Jørgensen ME, Hulman A, Dabelea D, Birkebaek NH, Svensson J, Rønn PF. Trajectory and predictors of HbA1c in children and adolescents with type 1 diabetes-A Danish nationwide cohort study. Pediatr Diabetes 2022; 23:721-728. [PMID: 35366046 DOI: 10.1111/pedi.13337] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Poor glycemic control in type 1 diabetes increases the risk of chronic complications and it is essential to identify life periods and predictors associated with deteriorating HbA1c . The aim was to describe specific HbA1c trajectories in Danish children and adolescents with type 1 diabetes and study associations with clinical and sociodemographic factors. RESEARCH DESIGN AND METHODS 5889 children with type 1 diabetes were included from the nationwide Danish Registry of Childhood and Adolescent Diabetes with annual visits during 1996-2019. Trajectories of HbA1c were modeled with linear mixed-effects models (using age as time scale, included as cubic spline) and with an individual-specific random intercept and slope. The following cofactors were included stepwise into the model: sex, age at diagnosis, calendar year, parental education, immigrant status, health care region, blood glucose monitoring (BGM) frequency, treatment modalities: continuous subcutaneous insulin infusion (pump) versus multiple daily insulin injection therapy (pen) and continuous glucose monitoring. RESULTS HbA1c overall increased during age while there was a significant decreasing secular trend. Older age at diagnosis was associated with a steeper trajectory, and non-Danish origin and shorter parental education were each associated with higher levels of HbA1c across age. A lower BGM frequency was associated with a markedly poorer HbA1c trajectory, while no significant differences were shown for different treatment modalities. CONCLUSIONS Glycemic outcome worsened with age during childhood and adolescence, which is of clinical concern. Important predictors for a poorer glycemic trajectory were later age at diabetes diagnosis, shorter parental education, non-Danish origin and, in particular low BGM frequency.
Collapse
Affiliation(s)
- Else Helene Ibfelt
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Rasmus Wibaek
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Dorte Vistisen
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Gregers S Andersen
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Marit E Jørgensen
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Dana Dabelea
- Colorado School of Public Health, Aurora, Colorado, USA
| | - Niels H Birkebaek
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Pernille F Rønn
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| |
Collapse
|
11
|
Rigalleau V, Larroumet A, Ducos C, Rigo M, Barbet-Massin MA, Majchrzak C, Mohammedi K, Baillet-Blanco L, Monlun M, Rami-Arab L, Foussard N. Cardiovascular events after a dramatic reduction of HbA1c in hospitalized subjects with type 2 diabetes and high long-term glucose exposure. J Diabetes Complications 2022; 36:108234. [PMID: 35752528 DOI: 10.1016/j.jdiacomp.2022.108234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In long-lasting diabetes, a dramatic reduction of HbA1c can precede adverse events such as worsening retinopathies or painful neuropathies. We have now analyzed its possible link with later cardiovascular events in subjects with type 2 diabetes, according to their long-term glucose exposure evaluated by skin autofluorescence (SAF) measured with an AGE-READER (Diagnoptics, Groningen, The Netherland). RESEARCH DESIGN AND METHODS We studied retrospectively a cohort of patients hospitalized for uncontrolled and/or complicated type 2 diabetes from 2009 to 2017. A previous dramatic reduction of HbA1c was defined by more than -1.5 %/4 months, and later cardiovascular events as myocardial infarction, stroke, revascularization procedures, and cardiovascular-related death. Survival analyses were performed before and after categorizing the subjects for their SAF. RESULTS The 386 subjects were 57.5 % men, 62 ± 9 years old, with a 14 ± 9 years duration of diabetes, most were treated by insulin (63.7 %). The dramatic HbA1c reducers (-3.0 ± 1.5 %) represented 16.5 % of the population. During the 51 months (IQR: 30-71) of follow-up, 53 cardiovascular events occurred and were related to the SAF (2.70 ± 0.64 AUs). Linkage was established between the SAF, the reduction of HbA1c and the cardiovascular events (p = 0.017). With a SAF higher than the median (2.65 AUs), the dramatic reduction of HbA1c was related to later cardiovascular events (HR: 3.84, 95%CI: 1.68-8.76). CONCLUSIONS A dramatic decline of HbA1c leads to a higher risk of cardiovascular events in hospitalized subjects with type 2 diabetes and a high long-term glucose exposure.
Collapse
Affiliation(s)
- Vincent Rigalleau
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, F-33600 Pessac, France; INSERM U1219 - Bordeaux Population Health Research Center, F-33000 Bordeaux, France.
| | - Alice Larroumet
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, F-33600 Pessac, France
| | - Claire Ducos
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, F-33600 Pessac, France
| | - Marine Rigo
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, F-33600 Pessac, France
| | | | - Camille Majchrzak
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, F-33600 Pessac, France
| | - Kamel Mohammedi
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, F-33600 Pessac, France; INSERM U1219 - Bordeaux Population Health Research Center, F-33000 Bordeaux, France
| | | | - Marie Monlun
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, F-33600 Pessac, France
| | - Lila Rami-Arab
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, F-33600 Pessac, France
| | - Ninon Foussard
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, F-33600 Pessac, France
| |
Collapse
|
12
|
Tremblay ES, Liu E, Laffel LM. Health Disparities Likely Emerge Early in the Course of Type-1 Diabetes in Youth. J Diabetes Sci Technol 2022; 16:929-933. [PMID: 35658634 PMCID: PMC9264423 DOI: 10.1177/19322968221082646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Type-1 diabetes (T1D) management and glycemic control the year after diagnosis affects the long-term trajectory of T1D. Disparities in hemoglobin A1c (HbA1c) based on race, ethnicity, and socioeconomic status (SES) have been well-documented; however, there has been limited investigation into the timeline with which these disparities develop. This study aims to assess differences in HbA1c by race/ethnicity and SES among youth with T1D over 1 year post diagnosis. METHODS HbA1c at onset, and 3, 6, 9, and 12 months following diagnosis was collected from youth with T1D between 2016 and 2020. Mixed-effect models examined associations of HbA1c over time with race/ethnicity and SES. RESULTS Of 758 patients, 71% identified as white. Mean (± SD) HbA1c was 11.4% ± 2.2% at diagnosis and 7.3% ± 1.2%, 7.3% ± 1.3%, 7.7% ± 1.4%, and 7.9% ± 1.4% at 3, 6, 9, and 12 months, respectively. HbA1c trajectories over time differed significantly by race (adjusting for sex and zip-code education and poverty levels) with Hispanic and black youth demonstrating higher HbA1c 1 year after diagnosis (8.7% vs 7.7%, p < .001) than white youth. CONCLUSIONS These data revealed that youth did not meet glycemic targets at 1 year post diagnosis and that racial/ethnic minority youth had higher HbA1c 1 year post diagnosis, highlighting the need to optimize glycemic control and mitigate disparities early. Understanding the time course of these outcomes helps to inform the need for early interventions, particularly in disadvantaged patient populations, to lay the groundwork for improved control. Further research must also be done to better understand overlapping axes of disparities including race, ethnicity, and SES.
Collapse
Affiliation(s)
- Elise Schlissel Tremblay
- Division of Endocrinology, Department
of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Elise Schlissel Tremblay, MD, MPH, Division
of Endocrinology, Boston Children’s Hospital, 333 Longwood Avenue, 6th Floor,
Boston, MA 02115, USA.
| | - Enju Liu
- Division of Endocrinology,
Institutional Centers for Clinical and Translational Research, Boston Children’s
Hospital, Boston, MA, USA
| | - Lori M. Laffel
- Division of Endocrinology, Department
of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Joslin Diabetes Center, Boston, MA,
USA
| |
Collapse
|
13
|
Lavikainen P, Aarnio E, Linna M, Jalkanen K, Tirkkonen H, Rautiainen P, Laatikainen T, Martikainen J. Data-driven long-term glycaemic control trajectories and their associated health and economic outcomes in Finnish patients with incident type 2 diabetes. PLoS One 2022; 17:e0269245. [PMID: 35648780 PMCID: PMC9159579 DOI: 10.1371/journal.pone.0269245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Treatments should be customized to patients to improve patients’ health outcomes and maximize the treatment benefits. We aimed to identify meaningful data-driven trajectories of incident type 2 diabetes patients with similarities in glycated haemoglobin (HbA1c) patterns since diagnosis and to examine their clinical and economic relevance. Materials and methods A cohort of 1540 patients diagnosed in 2011–2012 was retrieved from electronic health records covering primary and specialized healthcare in the North Karelia region, Finland. EHRs data were compiled with medication purchase data. Average HbA1c levels, use of medications, and incidence of micro- and macrovascular complications and deaths were measured annually for seven years since T2D diagnosis. Trajectories were identified applying latent class growth models. Differences in 4-year cumulative healthcare costs with 95% confidence intervals (CIs) were estimated with non-parametric bootstrapping. Results Four distinct trajectories of HbA1c development during 7 years after T2D diagnosis were extracted: patients with “Stable, adequate” (66.1%), “Slowly deteriorating” (24.3%), and “Rapidly deteriorating” glycaemic control (6.2%) as well as “Late diagnosed” patients (3.4%). During the same period, 2.2 (95% CI 1.9–2.6) deaths per 100 person-years occurred in the “Stable, adequate” trajectory increasing to 3.2 (2.4–4.0) in the “Slowly deteriorating”, 4.7 (3.1–6.9) in the “Rapidly deteriorating” and 5.2 (2.9–8.7) in the “Late diagnosed” trajectory. Similarly, 3.5 (95% CI 3.0–4.0) micro- and macrovascular complications per 100 person-years occurred in the “Stable, adequate” trajectory increasing to 5.1 (4.1–6.2) in the “Slowly deteriorating”, 5.5 (3.6–8.1) in the “Rapidly deteriorating” and 7.3 (4.3–11.8) in the “Late diagnosed” trajectory. Patients in the “Stable, adequate” trajectory had lower accumulated 4-year medication costs than other patients. Conclusions Data-driven patient trajectories have clinical and economic relevance and could be utilized as a step towards personalized medicine instead of the common “one-fits-for-all” treatment practices.
Collapse
Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- * E-mail:
| | - Emma Aarnio
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Kari Jalkanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Hilkka Tirkkonen
- Siun Sote – Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Päivi Rautiainen
- Siun Sote – Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Tiina Laatikainen
- Siun Sote – Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | |
Collapse
|
14
|
Holman N, Wild SH, Khunti K, Knighton P, O'Keefe J, Bakhai C, Young B, Sattar N, Valabhji J, Gregg EW. Incidence and Characteristics of Remission of Type 2 Diabetes in England: A Cohort Study Using the National Diabetes Audit. Diabetes Care 2022; 45:1151-1161. [PMID: 35320360 PMCID: PMC9174970 DOI: 10.2337/dc21-2136] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the incidence of remission of type 2 diabetes in routine care settings. RESEARCH DESIGN AND METHODS People with type 2 diabetes (HbA1c ≥48 mmol/mol [6.5%] or <48 mmol/mol [6.5%] with a prescription for glucose-lowering medications) alive on 1 April 2018 were identified from a national collation of health records in England and followed until 31 December 2019. Remission was defined as two HbA1c measurements of <48 mmol/mol (6.5%) at least 182 days apart, with no prescription for glucose-lowering medications 90 days before these measurements. RESULTS In 2,297,700 people with type 2 diabetes, the overall incidence of remission per 1,000 person-years was 9.7 (95% CI 9.6-9.8) and 44.9 (95% CI 44.0-45.7) in 75,610 (3.3%) people who were diagnosed <1 year. In addition to shorter duration of diagnosis, baseline factors associated with higher odds of remission were no prescription for glucose-lowering medication, lower HbA1c and BMI, BMI reduction, White ethnicity, female sex, and lower socioeconomic deprivation. Among 8,940 (0.4%) with characteristics associated with remission (diagnosed <2 years, HbA1c <53 mmol/mol [7.0%], prescribed metformin alone or no glucose-lowering medications, BMI reduction of ≥10%), incidence of remission per 1,000 person-years was 83.2 (95% CI 78.7-87.9). CONCLUSIONS Remission of type 2 diabetes was generally infrequent in routine care settings but may be a reasonable goal for a subset of people who lose a significant amount of weight shortly after diagnosis. Policies that encourage intentional remission of type 2 diabetes should seek to reduce the ethnic and socioeconomic inequalities identified.
Collapse
Affiliation(s)
- Naomi Holman
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Sarah H Wild
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, U.K
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Peter Knighton
- Analytical Services-Population Health, Clinical Audit and Specialist Care, NHS Digital, Leeds, U.K
| | - Jackie O'Keefe
- Analytical Services-Population Health, Clinical Audit and Specialist Care, NHS Digital, Leeds, U.K
| | | | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Jonathan Valabhji
- NHS England and NHS Improvement, London, U.K.,Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K.,Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Edward W Gregg
- School of Public Health, Imperial College London, London, U.K
| |
Collapse
|
15
|
Cahn A, Zuker I, Eilenberg R, Uziel M, Tsadok MA, Raz I, Lutski M. Machine learning based study of longitudinal HbA1c trends and their association with all-cause mortality: Analyses from a National Diabetes Registry. Diabetes Metab Res Rev 2022; 38:e3485. [PMID: 34233382 DOI: 10.1002/dmrr.3485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/05/2021] [Accepted: 06/19/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The association of long-term HbA1c variability with mortality has been previously suggested. However, the significance of HbA1c variability and trends in different age and HbA1c categories is unclear. RESEARCH DESIGN AND METHODS Data on patients with diabetes listed in the Israeli National Diabetes Registry during years 2012-2016 (observation period) were collected. Patients with >4 HbA1c measurements, type 1 diabetes, eGFR < 30mg/ml/min, persistent HbA1c < 6% or malignancy were excluded. Utilizing machine learning methods, patients were classified into clusters according to their HbA1c trend (increasing, stable, decreasing). Mortality risk during 2017-2019 was calculated in subgroups defined by age (35-54, 55-69, 70-89 years) and last HbA1c (≤7% and >7%) at end of observation period. Models were adjusted for demographic, clinical and laboratory measurements including HbA1c, standard deviation (SD) of HbA1c and HbA1c trend. RESULTS This historical cohort study included 293,314 patients. Increased HbA1c variability (high SD) during the observation period was an independent predictor of mortality in patients aged more than 55 years (p < 0.01). The HbA1c trend was another independent predictor of mortality. Patients with a decreasing versus stable HbA1c trend had a greater mortality risk; this association persisted in all age groups in patients with HbA1c > 7% at the end of the observation period (p = 0.02 in age 35-54; p < 0.01 in aged >55). Patients with an increasing versus stable HbA1c trend had a greater mortality risk only in the elderly group (>70), yet in both HbA1c categories (p < 0.01). CONCLUSIONS HbA1c variability and trend are important determinants of mortality risk and should be considered when adjusting glycaemic targets.
Collapse
Affiliation(s)
- Avivit Cahn
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Hebrew University Hospital, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbar Zuker
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel
| | - Roni Eilenberg
- TIMNA-Israel Ministry of Health's Big Data Platform, Ministry of Health, Jerusalem, Israel
| | - Moshe Uziel
- TIMNA-Israel Ministry of Health's Big Data Platform, Ministry of Health, Jerusalem, Israel
| | - Meytal Avgil Tsadok
- TIMNA-Israel Ministry of Health's Big Data Platform, Ministry of Health, Jerusalem, Israel
| | - Itamar Raz
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Hebrew University Hospital, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Miri Lutski
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel
| |
Collapse
|
16
|
Xiang AS, Szwarcbard N, Gasevic D, Earnest A, Pease A, Andrikopoulos S, Wischer N, Davis W, Zoungas S. Trends in glycaemic control and drug use in males and females with type 2 diabetes: Results of the Australian National Diabetes Audit from 2013 to 2019. Diabetes Obes Metab 2021; 23:2603-2613. [PMID: 34338406 DOI: 10.1111/dom.14506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022]
Abstract
AIM To investigate temporal changes in glycaemic control and the use of antihyperglycaemic therapies in females and males with type 2 diabetes from 2013 to 2019. METHODS Data from adult patients with type 2 diabetes (n = 11 930; 44.9% females, mean [SD] age of 62.9 [12.9] years) were analysed from the 2013 to 2019 biennial cross-sectional Australian National Diabetes Audit. RESULTS Mean HbA1c remained similar throughout the years examined and between the sexes (7.8%-8.3%, 62-67 mmol/mol; P > .05). The number of antihyperglycaemic agents used by both sexes increased from 2013 to 2019 (P < .001), with more agents used by males (P = .014). From 2013 to 2019, there were increasing proportions of both sexes using dipeptidyl peptidase-4 inhibitors (females: 11.7%-25.7%, P = .045; males: 11.6%-29.5%, P = .036) and glucagon-like peptide-1 receptor agonists (females: 5.9%-15.3%; males: 4.9%-11.1%; P = .043 for both). Sodium-glucose co-transporter-2 inhibitors were not available in 2013; however, their use increased substantially from 2015 to 2019 in both females (4.9%-26.3%, P = .013) and males (4.7%-32.2%, P = .019). CONCLUSIONS From 2013 to 2019, mean HbA1c levels remained unchanged despite a concurrent increase in the number of antihyperglycaemic medications used. Overall, there was a trend towards preferencing newer agents with some differences in treatment regimens relating to sex and renal function.
Collapse
Affiliation(s)
- Angie S Xiang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Naomi Szwarcbard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anthony Pease
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - Sof Andrikopoulos
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Australian Diabetes Society, Sydney, New South Wales, Australia
| | - Natalie Wischer
- National Association of Diabetes Centres, Sydney, New South Wales, Australia
| | - Wendy Davis
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| |
Collapse
|
17
|
Lifetime Cost-effectiveness of Oral Semaglutide Versus Dulaglutide and Liraglutide in Patients With Type 2 Diabetes Inadequately Controlled With Oral Antidiabetics. Clin Ther 2021; 43:1812-1826.e7. [PMID: 34728099 DOI: 10.1016/j.clinthera.2021.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/15/2021] [Accepted: 08/30/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To estimate the incremental cost-utility ratio of oral semaglutide (14 mg once daily) vs other glucagon-like peptide 1 receptor agonist treatments among adults with type 2 diabetes that was inadequately controlled with 1 to 2 oral antidiabetic drugs from a US payer perspective. METHODS A state-transition model with a competing risk approach was developed for diabetic complications and risk of cardiovascular events based on the UK Prospective Diabetes Study Outcomes Model 1 equations. Baseline population characteristics reflect the PIONEER 4 trial (Efficacy and Safety of Oral Semaglutide Versus Liraglutide and Versus Placebo in Subjects With Type 2 Diabetes Mellitus) of oral semaglutide. Model comparators included subcutaneous semaglutide, dulaglutide, and liraglutide. Treatment effects (change in glycosylated hemoglobin, weight, and systolic blood pressure) were estimated by network meta-analysis. Drug, management, and event costs (in 2019 US dollars), survival after nonfatal events, and utilities were obtained from the literature. Costs and quality-adjusted life-year (QALY) outcomes were discounted at 3% annually over a lifetime horizon. Probabilistic and 1-way sensitivity analyses were performed. FINDINGS Total estimated costs and QALYs were $144,065 and 12.98 for oral semaglutide, $145,721 and 12.96 for dulaglutide, $145,833 and 12.99 for SC semaglutide, and $149,428 and 12.97 for liraglutide, respectively. Oral semaglutide was less costly and more effective than dulaglutide and liraglutide but less costly than subcutaneous semaglutide with similar effectiveness. Oral semaglutide was favored versus subcutaneous semaglutide in 52.10% of model replications at a willingness-to-pay of $150,000 per QALY. IMPLICATIONS Oral semaglutide is predicted to offer health benefits similar to subcutaneous semaglutide and ahead of dulaglutide and liraglutide. Oral semaglutide is a cost-effective glucagon-like peptide 1 receptor agonist treatment option.
Collapse
|
18
|
Soldevila-Domenech N, Cuenca-Royo A, Babio N, Forcano L, Nishi S, Vintró-Alcaraz C, Gómez-Martínez C, Jiménez-Murcia S, Fernández-Carrión R, Gomis-González M, Alvarez-Sala A, Carlos S, Pintó X, Corella D, Díez-Espino J, Castañer O, Fernández-Aranda F, Salas-Salvadó J, de la Torre R. Metformin Use and Cognitive Function in Older Adults With Type 2 Diabetes Following a Mediterranean Diet Intervention. Front Nutr 2021; 8:742586. [PMID: 34676236 PMCID: PMC8523839 DOI: 10.3389/fnut.2021.742586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/07/2021] [Indexed: 12/28/2022] Open
Abstract
Background and Purpose: Both adherence to the Mediterranean diet (MedDiet) and the use of metformin could benefit the cognitive performance of individuals with type 2 diabetes, but evidence is still controversial. We examined the association between metformin use and cognition in older adults with type 2 diabetes following a MedDiet intervention. Methods: Prospective cohort study framed in the PREDIMED-Plus-Cognition sub-study. The PREDIMED-Plus clinical trial aims to compare the cardiovascular effect of two MedDiet interventions, with and without energy restriction, in individuals with overweight/obesity and metabolic syndrome. The present sub-study included 487 cognitively normal subjects (50.5% women, mean ± SD age of 65.2 ± 4.7 years), 30.4% of them (N = 148) with type 2 diabetes. A comprehensive battery of neurocognitive tests was administered at baseline and after 1 and 3 years. Individuals with type 2 diabetes that exhibited a good glycemic control trajectory, either using or not using metformin, were compared to one another and to individuals without diabetes using mixed-effects models with inverse probability of treatment weights. Results: Most subjects with type 2 diabetes (83.1%) presented a good and stable glycemic control trajectory. Before engaging in the MedDiet intervention, subjects using metformin scored higher in executive functions (Cohen's d = 0.51), memory (Cohen's d = 0.38) and global cognition (Cohen's d = 0.48) than those not using metformin. However, these differences were not sustained during the 3 years of follow-up, as individuals not using metformin experienced greater improvements in memory (β = 0.38 vs. β = 0.10, P = 0.036), executive functions (β = 0.36 vs. β = 0.02, P = 0.005) and global cognition (β = 0.29 vs. β = -0.02, P = 0.001) that combined with a higher MedDiet adherence (12.6 vs. 11.5 points, P = 0.031). Finally, subjects without diabetes presented greater improvements in memory than subjects with diabetes irrespective of their exposure to metformin (β = 0.55 vs. β = 0.10, P < 0.001). However, subjects with diabetes not using metformin, compared to subjects without diabetes, presented greater improvements in executive functions (β = 0.33 vs. β = 0.08, P = 0.032) and displayed a higher MedDiet adherence (12.6 points vs. 11.6 points, P = 0.046). Conclusions: Although both metformin and MedDiet interventions are good candidates for future cognitive decline preventive studies, a higher adherence to the MedDiet could even outweigh the potential neuroprotective effects of metformin in subjects with diabetes.
Collapse
Affiliation(s)
- Natalia Soldevila-Domenech
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Aida Cuenca-Royo
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Nancy Babio
- Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere i Virgili, Human Nutrition Unit, Universitat Rovira i Virgili, Reus, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Forcano
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Stephanie Nishi
- Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere i Virgili, Human Nutrition Unit, Universitat Rovira i Virgili, Reus, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Vintró-Alcaraz
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carlos Gómez-Martínez
- Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere i Virgili, Human Nutrition Unit, Universitat Rovira i Virgili, Reus, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Rebeca Fernández-Carrión
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Maria Gomis-González
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Andrea Alvarez-Sala
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Silvia Carlos
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Navarra Health Research Institute (IDISNA), Pamplona, Spain
| | - Xavier Pintó
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Lipid Unit, Department of Internal Medicine, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Dolores Corella
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Javier Díez-Espino
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Navarra Health Research Institute (IDISNA), Pamplona, Spain
| | - Olga Castañer
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Endocrinology Service, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Fernando Fernández-Aranda
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Jordi Salas-Salvadó
- Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere i Virgili, Human Nutrition Unit, Universitat Rovira i Virgili, Reus, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael de la Torre
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
19
|
Sherr JL, Schwandt A, Phelan H, Clements MA, Holl RW, Benitez-Aguirre PZ, Miller KM, Woelfle J, Dover T, Maahs DM, Fröhlich-Reiterer E, Craig ME. Hemoglobin A1c Patterns of Youth With Type 1 Diabetes 10 Years Post Diagnosis From 3 Continents. Pediatrics 2021; 148:peds.2020-048942. [PMID: 34315809 PMCID: PMC8785705 DOI: 10.1542/peds.2020-048942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Distinct hemoglobin A1c (HbA1c) trajectories during puberty are identified in youth with established type 1 diabetes (T1D). We used data from 3 international registries to evaluate whether distinct HbA1c trajectories occur from T1D onset. METHODS Participants were <18 years old at diagnosis with at least 1 HbA1c measured within 12 months post diagnosis, along with ≥3 duration-year-aggregated HbA1c values over 10 years of follow-up. Participants from the Australasian Diabetes Data Network (n = 7292), the German-Austrian-Luxembourgian-Swiss diabetes prospective follow-up initiative (Diabetes Patienten Verlaufsdokumentation) (n = 39 226) and the US-based Type 1 Diabetes Exchange Clinic Registry (n = 3704) were included. With group-based trajectory modeling, we identified unique HbA1c patterns from the onset of T1D. RESULTS Five distinct trajectories occurred in all 3 registries, with similar patterns of proportions by group. More than 50% had stable HbA1c categorized as being either low stable or intermediate stable. Conversely, ∼15% in each registry were characterized by stable HbA1c >8.0% (high stable), and ∼11% had values that began at or near the target but then increased (target increase). Only ∼5% of youth were above the target from diagnosis, with an increasing HbA1c trajectory over time (high increase). This group differed from others, with higher rates of minority status and an older age at diagnosis across all 3 registries (P ≤ .001). CONCLUSIONS Similar postdiagnostic HbA1c patterns were observed across 3 international registries. Identifying the youth at the greatest risk for deterioration in HbA1c over time may allow clinicians to intervene early, and more aggressively, to avert increasing HbA1c.
Collapse
Affiliation(s)
- Jennifer L. Sherr
- Division of Pediatric Endocrinology, Department of Pediatrics,
Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, Zentralinstitut
für Biomedizinische Technik, Ulm University, Ulm, Germany,German Centre for Diabetes Research, Munich-Neuherberg,
Germany
| | - Helen Phelan
- John Hunter Children’s Hospital, Newcastle,
Australia,Division of Child and Adolescent Health, The University of
Sydney, Sydney, Australia
| | - Mark A. Clements
- Children’s Mercy Hospital, Kansas City, Missouri,Department of Pediatrics, University of Missouri-Kansas City,
Kansas City, Missouri
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, Zentralinstitut
für Biomedizinische Technik, Ulm University, Ulm, Germany,German Centre for Diabetes Research, Munich-Neuherberg,
Germany
| | - Paul Z. Benitez-Aguirre
- Division of Child and Adolescent Health, The University of
Sydney, Sydney, Australia,Children’s Hospital at Westmead, Sydney, Australia
| | | | - Joachim Woelfle
- Children’s Hospital, University of Erlangen, Erlangen,
Germany
| | - Thomas Dover
- Ipswich Hospital, Brisbane, Australia,Mater Hospitals, Brisbane, Australia
| | - David M. Maahs
- Stanford Diabetes Research Center,Division of Endocrinology and Diabetes, Department of
Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical
University of Graz, Graz, Austria
| | - Maria E. Craig
- Division of Child and Adolescent Health, The University of
Sydney, Sydney, Australia,Children’s Hospital at Westmead, Sydney, Australia
| |
Collapse
|
20
|
Wu CJ, Huang KJ, Tsai YC, Yeh TP, Hsieh CF, Wang YJ. Peripheral Neuropathy: Comparison of Symptoms and Severity Between Colorectal Cancer Survivors and Patients With Diabetes. Clin J Oncol Nurs 2021; 25:395-403. [PMID: 34269355 DOI: 10.1188/21.cjon.395-403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peripheral neuropathy (PN) is a common symptom in colorectal cancer (CRC) survivors and patients with diabetes. However, the differences in PN symptoms between CRC survivors and patients with diabetes are not clear. OBJECTIVES The purpose of this study was to examine the differences in PN between CRC survivors and patients with diabetes. METHODS Secondary data were analyzed from two cross-sectional studies consisting of 81 CRC survivors and 86 patients with diabetes from two hospitals in northern and central Taiwan. Data were analyzed using descriptive statistics, analysis of covariance, and multiple logistic regression. FINDINGS Significant differences in severity and prevalence of PN and neuropathic pain between CRC survivors and patients with diabetes were found. Patients with diabetes had significantly more severe PN and sensory PN compared to CRC survivors. In addition, the prevalence of PN and neuropathic pain was significantly higher in CRC survivors compared to patients with diabetes after control of covariates.
Collapse
Affiliation(s)
| | | | - Yi-Chuan Tsai
- Christian Medical Foundation Lukang Christian Hospital
| | | | | | | |
Collapse
|
21
|
Wang JS, Liu WJ, Lee CL. HbA1c trajectory and cardiovascular outcomes: an analysis of data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Ther Adv Chronic Dis 2021; 12:20406223211026391. [PMID: 34249303 PMCID: PMC8239983 DOI: 10.1177/20406223211026391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022] Open
Abstract
Background: We investigated the associations between glycated hemoglobin (HbA1c) trajectories and cardiovascular outcomes using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Methods: We used HbA1c values within the first 2 years of treatment for modeling with a latent class growth model. Groups of HbA1c trajectories were modeled separately in the standard (group 1–group 4) and intensive (group 5–group 8) treatment arms. The primary outcome in the ACCORD study was a composite of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes. Effects of HbA1c trajectories on cardiovascular outcomes were analyzed using a Cox-proportional hazard model. Results: Baseline HbA1c levels for the eight trajectories (group 1–group 8) were 7.8 ± 0.8, 8.2 ± 0.9, 9.3 ± 1.1, 9.6 ± 1.2, 7.8 ± 0.7, 10.1 ± 0.8, 8.3 ± 0.7, and 9.5 ± 1.1%, respectively. The respective values after 2 years of treatment were 7.0 ± 0.6, 7.7 ± 0.7, 8.5 ± 0.9, 10.3 ± 1.3, 6.2 ± 0.4, 6.5 ± 0.6, 7.2 ± 0.6, and 8.5 ± 1.1%. After a median follow-up of 4.8 years, group 5 and group 6 had similar outcomes compared with group 1 (reference group). In contrast, group 3, group 4, and group 8 had higher risks of the primary composite outcome compared with group 1. Conclusion: HbA1c trajectory was associated with cardiovascular outcomes in type 2 diabetes patients with high cardiovascular risk.
Collapse
Affiliation(s)
- Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Wei-Ju Liu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
| | - Chia-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| |
Collapse
|
22
|
Langholz PL, Wilsgaard T, Njølstad I, Jorde R, Hopstock LA. Trends in known and undiagnosed diabetes, HbA1c levels, cardiometabolic risk factors and diabetes treatment target achievement in repeated cross-sectional surveys: the population-based Tromsø Study 1994-2016. BMJ Open 2021; 11:e041846. [PMID: 33757943 PMCID: PMC7993331 DOI: 10.1136/bmjopen-2020-041846] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate time trends in known and undiagnosed diabetes, glycated haemoglobin (HbA1c) levels and other cardiometabolic risk factors in the general population as well as treatment target achievement among those with diabetes. DESIGN AND SETTING Repeated cross-sectional surveys in the population-based Tromsø Study. METHODS We used age-adjusted generalised estimating equation models to study trends in self-reported and undiagnosed (HbA1c ≥6.5%) diabetes, cardiometabolic risk factors and the metabolic syndrome in 27 281 women and men aged 40-84 years examined in up to four surveys of the Tromsø Study between 1994 and 2016. Further, we analysed trends in diabetes treatment target achievement. RESULTS During 1994-2016, diabetes prevalence increased in women (2.3% to 4.6%) and men (2.4% to 5.8%) and in all age groups, while the proportion of undiagnosed diabetes in women (32% to 17%) and men (37% to 24%) decreased. Blood pressure and total cholesterol decreased, while waist circumference increased in participants with and without diabetes, leading to a relatively stable prevalence of the metabolic syndrome throughout the study period. There was a marginal increase in HbA1c levels among participants without diabetes. Only half of those with diabetes achieved the treatment target of HbA1c ≤7.0%. CONCLUSION In the last two decades, diabetes prevalence increased, while the proportion of undiagnosed diabetes declined. The prevalence of the metabolic syndrome remained stable throughout, driven by opposing trends with an increase in obesity and a decrease in other cardiometabolic risk factors. HbA1c treatment target achievement did not improve.
Collapse
Affiliation(s)
- Petja Lyn Langholz
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rolf Jorde
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | | |
Collapse
|
23
|
Keenan ME, Berlin KS, Cook JL, Ankney RL, Klages KL, Semenkovich KA, Rybak TM, Banks GG, Choquette AE, Alemzadeh R, Eddington AR. Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes. J Pediatr Psychol 2021; 46:241-250. [PMID: 33398334 DOI: 10.1093/jpepsy/jsaa124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Following the Journal of Pediatric Psychology's special edition on health disparities, calling for Phase 2 research exploring mechanisms of racial groups in health disparities, this study aims to explore social information processing predictors of longitudinal hemoglobin A1c (HbA1c) trajectories in a racially diverse group of adolescents. The social information processing model of glycemic control in type 1 diabetes (T1D) posits that adolescents who make negative attributions about reactions of friends are likely to find adherence difficult in social situations, have increased stress, and have suboptimal glycemic control. METHODS One hundred eighty-four youth with T1D completed self-report measures and HbA1c at three time points within 1 year was extracted from medical records. Growth mixture modeling empirically derived classes of HbA1c trajectories and explored predictive relationships of social information processing variables, demographics, and diabetes characteristics. RESULTS Three classes emerged: High Decelerating, Mid-High Accelerating, and Near-Optimal Accelerating. Black/African American participants were highly likely to be in the High and Mid-High groups. Higher anticipated adherence difficulties in social situations predicted increased odds of being in the Mid-High versus Near-Optimal HbA1c group. Increased diabetes stress predicted increased odds of being in the High versus Near-Optimal and Mid-High groups. CONCLUSIONS Continuing research on mechanisms behind this health disparity is necessary with more representation from varied racial and ethnic groups. Equal access to diabetes technology and psychosocial treatments are recommended and implications for clinical intervention development are discussed.
Collapse
Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| | | | | | | | | | - Tiffany M Rybak
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | - Ramin Alemzadeh
- Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| |
Collapse
|
24
|
Zhang ZP, Premikha M, Luo M, Venkataraman K. Diabetes distress and peripheral neuropathy are associated with medication non-adherence in individuals with type 2 diabetes in primary care. Acta Diabetol 2021; 58:309-317. [PMID: 33211180 DOI: 10.1007/s00592-020-01609-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/23/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Psychosocial factors like diabetes distress and social support, as well as the presence of complications, affect an individual's self-management ability; however, their role in adherence behaviours is not yet clear. We examined the role of psychosocial factors and complications in non-adherence behaviours in individuals with diabetes in primary care. METHODS Baseline survey with nine-month follow up through medical records of patients with type 2 diabetes attending primary care. Medication adherence and diabetes distress were assessed using Morisky Green Levine Medication Adherence Scale and Problem Areas in Diabetes, respectively. Appointment adherence was assessed through medical records. RESULTS Of the 448 participants studied, 59.8% had medication non-adherence and 21.7% were non-adherent to scheduled appointments. PAID score (odds ratio (OR) 1.01, 95% confidence interval 1.00-1.03, p = 0.013), peripheral neuropathy (OR 1.99, 95%CI 1.18-3.37, p = 0.01), home glucose monitoring (OR 0.46, 95%CI 0.30-0.69, p < 0.001), HbA1c (OR 1.34, 95%CI 1.13-1.61, p = 0.001), and age (OR 0.96, 95%CI 0.93-0.98, p = 0.001) were associated with medication non-adherence. Indian ethnicity (OR 2.93, 95%CI 1.59-5.39, p = 0.001), secondary or higher education (OR 1.94, 95%CI 1.14-3.27, p = 0.014), and HbA1c (OR 1.38, 95%CI 1.18-1.63, p < 0.001) were associated with appointment non-adherence. CONCLUSIONS Non-adherence behaviours were prevalent and significantly associated with higher HbA1c. Medication non-adherence was more likely in younger individuals, those with higher diabetes distress or peripheral neuropathy. Appointment non-adherence was more likely in individuals of Indian ethnicity or those with higher education. Greater support for these groups may help improve adherence behaviours and outcomes.
Collapse
Affiliation(s)
| | - M Premikha
- Ministry of Health Holdings Pte Ltd, Singapore, Singapore
| | - Miyang Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 10-03J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, 10-03J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore.
| |
Collapse
|
25
|
An LW, Li XL, Chen LH, Tang H, Yuan Q, Liu YJ, Ji Y, Lu JM. Clinical Inertia and 2-Year Glycaemic Trajectories in Patients with Non-Newly Diagnosed Type 2 Diabetes Mellitus in Primary Care: A Retrospective Cohort Study. Patient Prefer Adherence 2021; 15:2497-2508. [PMID: 34795477 PMCID: PMC8593594 DOI: 10.2147/ppa.s328165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/27/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To analyse diabetes treatment, treatment change and self-management behaviours in association with 2-year glycaemic trajectories in patients with non-newly diagnosed type 2 diabetes mellitus in Chinese primary care. METHODS This was an observational, multi-centre, longitudinal, retrospective cohort study. Clinical data of 4690 subjects were extracted from electronic medical records, including serial glycated haemoglobin A1c (HbA1c) measurements, antidiabetic medication records and compliance to exercise, diet, medications and self-monitoring of blood glucose (SMBG). Patterns of longitudinal HbA1c trajectories were identified using the percentage of HbA1c measurements <7.5% from the second available HbA1c measurement. Clinical relevance of the clusters was assessed through multivariable analysis. RESULTS Approximately half of the participants demonstrated good glycaemic control; of these, 34.5% demonstrated stable, good control, and 13.7% demonstrated relatively good control. About 16.2% demonstrated moderate control, and 35.6% demonstrated poor control. From the good to poor control groups, the percentage of subjects treated with insulin at baseline and during the follow-up period increased gradually, while the percentage of subjects adhering to exercise, diet, medications and SMBG decreased gradually. Compared with baseline, the adherence to exercise, diet, medications and SMBG improved significantly. Approximately 50% and 26% of subjects in the two poorest control groups, respectively, experienced treatment changes. After multivariable adjustments, baseline HbA1c ≥7.5%, HbA1c change ≥-0.5% from baseline to visit 1, insulin treatment, treatment change, poor adherence to diet, exercise, SMBG during the follow-up period and HbA1c measurements <3 per year were significantly associated with poorer glycaemic control. CONCLUSION We identified four longitudinal HbA1c trajectories in patients with non-newly diagnosed type 2 diabetes. Even if baseline HbA1c is suboptimal, aggressive treatment changes, good adherence during the follow-up period, ≥3 HbA1c measurements per year and reducing HbA1c levels to a certain extent by the first follow-up visit were important for good, stable, long-term glycaemic control.
Collapse
Affiliation(s)
- Ling-Wang An
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Xiang-Lan Li
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Lin-Hui Chen
- Department of Endocrinology, Taiyuan Diabetes Hospital, Taiyuan, 030013, People’s Republic of China
| | - Hong Tang
- Department of Share-Care Center, Chengdu Ruien Diabetes Hospital, Chengdu, 610000, People’s Republic of China
| | - Qun Yuan
- Department of Endocrinology, Heilongjiang Ruijing Diabetes Hospital, Harbin, 150009, People’s Republic of China
| | - Yan-Jun Liu
- Department of Endocrinology, Lanzhou Ruijing Diabetes Hospital, Lanzhou, 730000, People’s Republic of China
| | - Yu Ji
- Department of Endocrinology, Beijing Aerospace General Hospital, Beijing, 100076, People’s Republic of China
| | - Ju-Ming Lu
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
- Department of Endocrinology, The General Hospital of the People’s Liberation Army, Beijing, 100853, People’s Republic of China
- Correspondence: Ju-Ming Lu Department of Endocrinology, The General Hospital of the People’s Liberation Army, No. 28 of Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of ChinaTel +86 10 8822 9999 Email
| |
Collapse
|
26
|
Larroumet A, Foussard N, Monlun M, Blanco L, Mohammedi K, Rigalleau V. Comment on Pantalone et al. The Probability of A1C Goal Attainment in Patients With Uncontrolled Type 2 Diabetes in a Large Integrated Delivery System: A Prediction Model. Diabetes Care 2020;43:1910-1919. Diabetes Care 2020; 43:e198. [PMID: 33218982 DOI: 10.2337/dc20-1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alice Larroumet
- CHU de Bordeaux, Department of Endocrinology-Diabetology-Nutrition, Bordeaux, France
| | - Ninon Foussard
- CHU de Bordeaux, Department of Endocrinology-Diabetology-Nutrition, Bordeaux, France
| | - Marie Monlun
- CHU de Bordeaux, Department of Endocrinology-Diabetology-Nutrition, Bordeaux, France
| | - Laurence Blanco
- CHU de Bordeaux, Department of Endocrinology-Diabetology-Nutrition, Bordeaux, France
| | - Kamel Mohammedi
- CHU de Bordeaux, Department of Endocrinology-Diabetology-Nutrition, Bordeaux, France
| | - Vincent Rigalleau
- CHU de Bordeaux, Department of Endocrinology-Diabetology-Nutrition, Bordeaux, France
| |
Collapse
|
27
|
An J, Nichols GA, Qian L, Harrison TN, Li Z, Munis MA, Wei R, Weiss T, Rajpathak S, Reynolds K. Time in suboptimal glycemic control over 10 years for patients newly diagnosed with type 2 diabetes. J Diabetes Complications 2020; 34:107607. [PMID: 32499115 DOI: 10.1016/j.jdiacomp.2020.107607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate time in suboptimal glycemic control among patients with incident type 2 diabetes (T2D) over 10 years. METHODS We calculated percent of time in suboptimal glycemic control using three A1C thresholds (8%, 7.5%, 7%) following T2D diagnosis. Stratified analyses were conducted based on age and A1C levels at T2D diagnosis. RESULTS We identified 28,315 patients with incident T2D. Percent of time in suboptimal glycemic control increased with T2D duration. Mean percent time in suboptimal A1C control in the first 2 years following diagnosis was 30%, 34% and 40% for the 8%, 7.5%, and 7% thresholds, respectively. In the 6-10 years following T2D diagnosis, the percent time in suboptimal A1C control increased to 39%, 48% and 61%, for the 8%, 7.5%, and 7% thresholds, respectively. Time in suboptimal glycemic control was longer among younger patients aged 20-44 versus ≥65 years and those with higher A1C (>8%) versus lower A1C (<7%) at diagnosis. CONCLUSIONS Over 10 years following diagnosis, T2D patients spent one-third to over one-half of their time in suboptimal glycemic control. Reducing time spent above desired A1C targets could lower risk of microvascular and macrovascular complications.
Collapse
Affiliation(s)
- Jaejin An
- Kaiser Permanente Southern California, Pasadena, CA, USA.
| | | | - Lei Qian
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Zhuoxin Li
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Rong Wei
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | | |
Collapse
|
28
|
Bharmal SH, Cho J, Alarcon Ramos GC, Ko J, Stuart CE, Modesto AE, Singh RG, Petrov MS. Trajectories of glycaemia following acute pancreatitis: a prospective longitudinal cohort study with 24 months follow-up. J Gastroenterol 2020; 55:775-788. [PMID: 32494905 DOI: 10.1007/s00535-020-01682-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023]
Abstract
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%), moderate-stable 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.
Collapse
Affiliation(s)
- Sakina Huseni Bharmal
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Jaelim Cho
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | | | - Juyeon Ko
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Charlotte Elizabeth Stuart
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Andre Eto Modesto
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Ruma Girish Singh
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Maxim Sergey Petrov
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand.
| |
Collapse
|
29
|
Sadera R, Wijeratne S, Baskar V. Comparative evaluation of quality of diabetes care within a population using discrete HbA1c thresholds versus longitudinal trends within a defined time period. Postgrad Med J 2020; 96:629-630. [PMID: 32354702 DOI: 10.1136/postgradmedj-2020-137712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND HbA1c is a quality measurement for a population's diabetes care. Currently, discrete values are used to judge the care quality. However, an improved trend may have been achieved without reaching a discrete threshold. We aimed to compare the quality of glycaemic care using discrete thresholds versus longitudinal trends of a patient's HbA1c. METHODS We derived a study population of 4062 with two consecutive HbA1c's within 1-6 months. We used current discrete thresholds and then used these to define the longitudinal thresholds (the change in HbA1c between the first and second measurement). RESULTS We found that even with discrete thresholds, overall care was improving with 61% (Excellent care), 13% (Good care), 13% (Average care) and 13% (Poor care) turning into 68%, 12%, 11% and 9%, respectively (χ² 3335, p<0.0001). Using longitudinal trends shows a greater improvement of care with the original values achieving 74%, 7%, 9%, 7% and 4%, respectively (χ² 4111.3, p<0.0001). There was an additional 28% (Good care), 15% (Average care) and 12% (Poor and Very poor care) who with longitudinal trends improved to an excellent category without being identified as such. CONCLUSION Our study highlights the need to consider longitudinal trends when measuring quality of diabetes care.
Collapse
Affiliation(s)
- Rohan Sadera
- Medicine, University of Buckingham, Buckingham, UK
| | - Sethsiri Wijeratne
- Endocrinology, South Warwickshire NHS Foundation Trust, Warwick, Warwickshire, UK
| | - Varadarajan Baskar
- Medicine, University of Buckingham, Buckingham, UK.,Endocrinology, South Warwickshire NHS Foundation Trust, Warwick, Warwickshire, UK
| |
Collapse
|
30
|
Three-Variate Longitudinal Patterns of Metabolic Control, Body Mass Index, and Insulin Dose during Puberty in a Type 1 Diabetes Cohort: A Group-Based Multitrajectory Analysis. J Pediatr 2020; 218:64-71.e3. [PMID: 31952845 DOI: 10.1016/j.jpeds.2019.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To analyze the interrelationship of metabolic control, age- and sex-adjusted body mass index, and daily insulin dose and to identify heterogeneous multivariate developmental curves from childhood to young adulthood in a large cohort of children with type 1 diabetes (T1D) STUDY DESIGN: Data were extracted from the diabetes follow-up registry DPV. Longitudinal data from 9239 participants with T1D age 8-18 years with diabetes duration ≥2 years and ≥5 years of follow-up were analyzed. We applied group-based multitrajectory modeling to identify latent groups of subjects following similar developmental curves across outcomes (hemoglobin A1c [HbA1c], age/sex-standardized body mass index [BMI-SDS], daily insulin dose per kg). Group number was based on Bayes information criterion and group size (≥5%). RESULTS The group-based multitrajectory approach revealed 5 heterogeneous 3-variate trajectories during puberty. Individuals with stable good metabolic control, high-normal increasing BMI-SDS, and rising insulin dose patterns were classified as group 1 (33%). Group 2 (20%) comprised youths with intermediate-increasing HbA1c, low BMI-SDS, and steeply increasing insulin dose trajectories. Group 3 (11%) followed intermediate-rising HbA1c and high-normal increasing BMI-SDS developmental curves, while insulin dose increased steeply. In group 4 (14%), both high-increasing HbA1c and insulin dose trajectories were observed, while BMI-SDS was stable-normal. Group 5 (22%) included subjects with intermediate-rising HbA1c patterns, high-increasing BMI-SDS, and increasing insulin dose patterns. CONCLUSIONS This study identified 5 distinct 3-variate curves of HbA1c, BMI-SDS, and insulin dose during puberty among youths with T1D. This approach demonstrates a considerable heterogeneity highlighting the importance of personalized medical care.
Collapse
|
31
|
Wallis KA, Wells S, Selak V, Poppe K. Long-term follow up of older people on diabetes medications: observational study using linked health databases. Aust J Prim Health 2020; 26:306-312. [DOI: 10.1071/py19246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/13/2020] [Indexed: 11/23/2022]
Abstract
There is uncertainty about the long-term benefits and risks of diabetes medications in older people. We investigated differences in hypoglycaemia, cardiovascular disease (CVD) or mortality in older people according to diabetes medication, using linked national hospitalisation and mortality data from New Zealand. Adults aged ≥65 years dispensed diabetes medication in 2010 with a baseline glycated haemoglobulin (HbA1c) level (n=18099, mean age 73 years, 50% female) were included and stratified into four groups: metformin-only (42%); metformin-plus-other-oral-hypoglycaemic/s (27%); other-oral/s-only (11%); and any-insulin (20%). Time to first event was analysed with Cox models adjusted for sociodemographic factors; clinical history (prior hospitalisation for diabetes or CVD, and comorbidities); glycated haemoglobin; and CVD medications. Over 7-year follow up, 16% of participants experienced hypoglycaemia, 36% a CVD event and 31% died. Compared with metformin-only, insulin and other oral hypoglycaemic/s were associated with five- to 10-fold long-term increased risk of hypoglycaemia, and increased risk of CVD and death although adjusted survival curves showed no important separation between medication groups for CVD and death with the possible exception of insulin. Although confounding by indication is unable to be eliminated, this study raises further questions about the use of second-line diabetes medications in older people.
Collapse
|
32
|
Clements MA, Schwandt A, Donaghue KC, Miller K, Lück U, Couper JJ, Foster N, Schröder C, Phelan H, Maahs D, Prinz N, Craig ME. Five heterogeneous HbA1c trajectories from childhood to adulthood in youth with type 1 diabetes from three different continents: A group-based modeling approach. Pediatr Diabetes 2019; 20:920-931. [PMID: 31418521 DOI: 10.1111/pedi.12907] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Only a fraction of youth meet established targets for glycemic control; many experience deteriorating control over time. We compared trajectories of hemoglobin A1c (HbA1c) among youth from three trans-continental type 1 diabetes (T1D) registries and identified clinical variables associated with the odds of following increasing vs stable trajectories. RESEARCH DESIGN AND METHODS Analyses included longitudinal data from 15 897 individuals age 8 to 18 with T1D for at least 2 years and HbA1c measurements in at least 5 years during the observation period. Cohorts were selected from Australasian Diabetes Data Network (ADDN; Australia), German/Austrian/Luxembourgian Diabetes-Patienten-Verlaufsdokumentation initiative (DPV; Germany/Austria/Luxembourga), and the T1D Exchange Clinic Network (T1DX; US) clinic registries. Group-based trajectory modeling and multivariable logistic regression identified unique HbA1c trajectories and their predictors. RESULTS Five heterogeneous trajectories of glycemic control in each registry were identified: low, intermediate, high stable; intermediate and high increasing. The overall HbA1c level for each trajectory group tended to be lowest in the DPV, higher in the ADDN, and highest in the T1DX. The absolute level of HbA1c and the proportion of individuals within each trajectory varied across registries: 17% to 22% of individuals followed an increasing trajectory. Compared with maintaining a stable trajectory, following an increasing trajectory was significantly associated with ethnic minority status, lower height z-score, higher BMI z-score, insulin injection therapy, and the occurrence of severe hypoglycemia; however, these factors were not consistent across the three registries. CONCLUSIONS We report the first multinational registry-based comparison of glycemic control trajectories among youth with T1D from three continents and identify possible targets for intervention in those at risk of an increasing HbA1c trajectory.
Collapse
Affiliation(s)
- Mark A Clements
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Mercy Hospital, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,University of Sydney, New South Wales, Australia
| | | | - Ursula Lück
- Medical Centre, University St. Pölten, St. Pölten, Austria
| | - Jennifer J Couper
- Womens and Childrens Hospital and Robinson Research Institute, University of Adelaide, Adelaide, South Australia
| | | | - Carmen Schröder
- Department of Pediatrics, University of Greifswald, Greifswald, Germany
| | - Helen Phelan
- John Hunter Children's Hospital, Newcastle, Australia
| | - David Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Palo Alto, California
| | - Nicole Prinz
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,University of Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | | |
Collapse
|
33
|
Rathmann W, Schwandt A, Hermann JM, Kuss O, Roden M, Laubner K, Best F, Ebner S, Plaumann M, Holl RW. Distinct trajectories of HbA 1c in newly diagnosed Type 2 diabetes from the DPV registry using a longitudinal group-based modelling approach. Diabet Med 2019; 36:1468-1477. [PMID: 31392761 DOI: 10.1111/dme.14103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/09/2023]
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.
Collapse
Affiliation(s)
- W Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - A Schwandt
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - J M Hermann
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - O Kuss
- Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - M Roden
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - K Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre, University of Freiburg, Germany
| | - F Best
- Diabetes Practice Dr. Best, Essen, Germany
| | - S Ebner
- Medical Campus III, Clinic for Internal Medicine 2, Kepler University Hospital, Linz, Austria
| | - M Plaumann
- Specialist Diabetes Practice Hannover, Hannover, Germany
| | - R W Holl
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| |
Collapse
|
34
|
Luo M, Tan CS, Lim WY, Chia KS, Tang WE, Tai ES, Venkataraman K. Association of diabetes treatment with long-term glycemic patterns in patients with type 2 diabetes mellitus: A prospective cohort study. Diabetes Metab Res Rev 2019; 35:e3122. [PMID: 30600922 PMCID: PMC6590368 DOI: 10.1002/dmrr.3122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 01/06/2023]
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.
Collapse
Affiliation(s)
- Miyang Luo
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
| | | | - Kee Seng Chia
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | | | - E. Shyong Tai
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
- Division of EndocrinologyNational University HospitalSingapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
| |
Collapse
|
35
|
Nagy A, Kovács N, Pálinkás A, Sipos V, Vincze F, Szőllősi G, Ádány R, Czifra Á, Sándor J. Improvement in Quality of Care for Patients with Type 2 Diabetes in Hungary Between 2008 and 2016: Results from Two Population-Based Representative Surveys. Diabetes Ther 2019; 10:757-763. [PMID: 30771162 PMCID: PMC6437308 DOI: 10.1007/s13300-019-0582-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Due to the increasing trends of recent decades, diabetes prevalence has reached a frequency of 1/11 adults worldwide. However, this disadvantageous trend has not been accompanied by worsened outcome indicators; better short-term (e.g., HbA1c levels) and long-term [e.g., all-cause mortality among type 2 diabetes mellitus (T2DM) patients] outcomes can be observed globally. We aimed to describe changes in the effectiveness of type 2 diabetes mellitus care between 2008 and 2016 based on outcome indicators. METHODS The study is a secondary analysis of data from two previously performed surveys. Both surveys were conducted in the framework of the General Practitioners' Morbidity Sentinel Stations Program (GPMSSP), which maintains a nationally representative registry of T2DM patients. RESULTS The largest improvement was observed in achieving fasting blood glucose and HbA1c target values [OR = 0.67, 95% confidence interval (CI), 0.56-0.80 and OR = 0.58; 95% CI, 0.48-0.70, respectively]. Moderate improvement was detected by reaching body mass index (BMI), diastolic blood pressure and total cholesterol target values (OR = 0.78, 95% CI, 0.65-0.93; OR = 0.78, 95% CI, 0.65-0.94 and OR = 0.76, 95% CI, 0.63-0.92, respectively). CONCLUSION Our study demonstrated that if standardized indicators are investigated in population-based samples, the effectiveness of T2DM care can be monitored by ad hoc surveys. The systematic application of this approach completed with the detailed documentation of the applied therapies could demonstrate the public health impact of certain modifications in T2DM care. An overall improvement in metabolic control (glycaemic control, lipid status and obesity) was observed, which was not accompanied by improved therapeutic target achievement for systolic blood pressure.
Collapse
Affiliation(s)
- Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gergő Szőllősi
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Árpád Czifra
- General Practitioners' Cluster Haláp, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
| |
Collapse
|
36
|
Rigalleau V, Benoit J, Charret L, Bertrand C, Foussard N, Blanco L, Alexandre L, Monlun M, Mohammedi K. Longitudinal trends in HbA1c in diabetes: Stable means can hide meaningful long-term changes. Diabetes Metab Res Rev 2018; 34:e3065. [PMID: 30123984 DOI: 10.1002/dmrr.3065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/02/2018] [Accepted: 07/29/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Vincent Rigalleau
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Julie Benoit
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Léa Charret
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Capucine Bertrand
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Ninon Foussard
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Laurence Blanco
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Laure Alexandre
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Marie Monlun
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Kamel Mohammedi
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| |
Collapse
|
37
|
Luo M, Tan KHX, Tan CS, Lim WY, Tai E, Venkataraman K. Longitudinal trends in HbA 1c patterns and association with outcomes: A systematic review. Diabetes Metab Res Rev 2018; 34:e3015. [PMID: 29663623 PMCID: PMC6175395 DOI: 10.1002/dmrr.3015] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/03/2018] [Accepted: 04/05/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study aimed to review studies that identified patterns of longitudinal HbA1c trends in patients with diabetes and to summarize factors and outcomes associated with distinct trajectory patterns. METHODS PubMed and Web of Science were systematically searched for studies examining HbA1c trends among patients with diabetes from database inception through September 2017. Articles were included if they met the following inclusion criteria: (a) longitudinal study of subjects with diabetes only, (b) use of serial measurements of HbA1c , and (c) analysis of the trend of HbA1c using group-based trajectory approaches. RESULTS Twenty studies were included, 11 on type 1 diabetes and 9 on type 2 diabetes. These studies identified 2 to 6 HbA1c trajectory patterns. The most commonly identified patterns included stable HbA1c around 7.0% and at levels between 8.0% and 9.9%, which usually captured the HbA1c pattern among the majority of subjects in the study population. Unstable patterns identified included increasing HbA1c trend, decreasing HbA1c trend, and non-linear patterns. These patterns were associated with differential risk of disease outcomes, over and beyond single-point HbA1c measures. Age, gender, ethnicity, diabetes duration, disease management frequency, cardiovascular risk factors, insulin treatment, family environment, and psychosocial factors were the most frequently reported factors associated with membership of specific HbA1c pattern groups. CONCLUSION Common patterns of longitudinal HbA1c trends were identified despite heterogeneity among the studies. A better understanding of what underlies these different patterns may provide opportunities to tailor therapies and care for these patients to reduce adverse outcomes.
Collapse
Affiliation(s)
- Miyang Luo
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | | | - Chuen Seng Tan
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Wei Yen Lim
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - E‐Shyong Tai
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
- Division of EndocrinologyNational University HospitalSingapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| |
Collapse
|