TY - JOUR
T1 - Distinct trajectories in HbA1c are associated with different all-cause mortality and morbidity in newly diagnosed patients with type 2 diabetes
AU - Hemo, Beatriz
AU - Geva, Dikla
AU - Shahar, Danit R.
AU - Golan, Rachel
AU - Heymann, Anthony D.
N1 - Funding Information:
This study was funded by the Chief-Physician of Maccabi Healthcare Services (MHS). The MHS provided funding for statistical analysis assistance. The funder did not have any role in the design and conduct of this study.
Publisher Copyright:
© 2019
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Aims: To identify trajectories of long-term HbA1c levels and examine associations with subsequent risk for morbidity and mortality. Methods: We conducted a longitudinal follow-up among 27,724 patients, newly diagnosed with type 2 diabetes, in a large healthcare organization. We identified trajectories of long-term HbA1c levels during the first 5 years post diabetes onset to examine associations with subsequent risk for morbidity and all-cause mortality. Results: We identified two HbA1c trajectories; the “Steady-plateau HbA1c trajectory” in 93% of patients and a “Sharp-incline HbA1c trajectory” in 7% of patients. When compared to the steady-plateau group, patients in the sharp-incline group were younger, male, from a lower socio-economic background, and higher levels of HbA1c at baseline. Patients in the sharp-incline trajectory had a HR = 1.83 (95%CI: 1.58–2.12) for all-cause mortality, HR = 1.99 (95%CI: 1.74–2.27) for cardiovascular disease, and HR = 1.68 (95%CI: 1.51–1.86) for renal disease, compared to patients in the steady-plateau trajectory. Conclusions: Patients in the sharp-incline trajectory had a higher risk for all-cause mortality, cardiovascular disease, and renal disease, compared to patients in the steady-plateau trajectory. Estimation of HbA1c variability in the first years of diagnosis may be a useful indicator of those patients at high risk for diabetes related complications.
AB - Aims: To identify trajectories of long-term HbA1c levels and examine associations with subsequent risk for morbidity and mortality. Methods: We conducted a longitudinal follow-up among 27,724 patients, newly diagnosed with type 2 diabetes, in a large healthcare organization. We identified trajectories of long-term HbA1c levels during the first 5 years post diabetes onset to examine associations with subsequent risk for morbidity and all-cause mortality. Results: We identified two HbA1c trajectories; the “Steady-plateau HbA1c trajectory” in 93% of patients and a “Sharp-incline HbA1c trajectory” in 7% of patients. When compared to the steady-plateau group, patients in the sharp-incline group were younger, male, from a lower socio-economic background, and higher levels of HbA1c at baseline. Patients in the sharp-incline trajectory had a HR = 1.83 (95%CI: 1.58–2.12) for all-cause mortality, HR = 1.99 (95%CI: 1.74–2.27) for cardiovascular disease, and HR = 1.68 (95%CI: 1.51–1.86) for renal disease, compared to patients in the steady-plateau trajectory. Conclusions: Patients in the sharp-incline trajectory had a higher risk for all-cause mortality, cardiovascular disease, and renal disease, compared to patients in the steady-plateau trajectory. Estimation of HbA1c variability in the first years of diagnosis may be a useful indicator of those patients at high risk for diabetes related complications.
KW - Adult onset diabetes mellitus
KW - Diabetes complications
KW - Glycated hemoglobin A
KW - Mortality
KW - Time factors
UR - http://www.scopus.com/inward/record.url?scp=85076511877&partnerID=8YFLogxK
U2 - 10.1016/j.pcd.2019.11.009
DO - 10.1016/j.pcd.2019.11.009
M3 - Article
C2 - 31836307
AN - SCOPUS:85076511877
VL - 14
SP - 413
EP - 419
JO - Primary Care Diabetes
JF - Primary Care Diabetes
SN - 1751-9918
IS - 5
ER -
