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Distinct HbA1c trajectories in a type 2 diabetes cohort

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Abstract

Aims

The aim of this study was to identify subgroups of type 2 diabetes mellitus patients with distinct hemoglobin A1c (HbA1c) trajectories. Subgroup characteristics were determined and the prevalence of microvascular complications over time was investigated.

Study design and setting

Data from a cohort of 5,423 type 2 diabetes patients from a managed primary care system were used [mean follow-up 5.7 years (range 2–9 years)]. Latent class growth modeling was used to identify subgroups of patients with distinct HbA1c trajectories. Multinomial logistic regression analyses were conducted to determine which characteristics were associated with different classes.

Results

Four subgroups were identified. The first and largest subgroup (83 %) maintained good glycemic control over time (HbA1c ≤53 mmol/mol), the second subgroup (8 %) initially showed severe hyperglycemia, but reached the recommended HbA1c target within 2 years. Patients within this subgroup had significantly higher baseline HbA1c levels but were otherwise similar to the good glycemic control group. The third subgroup (5 %) showed hyperglycemia and a delayed response without reaching the recommended HbA1c target. The fourth subgroup (3.0 %) showed deteriorating hyperglycemia over time. Patients within the last two subgroups were significantly younger, had higher HbA1c levels and a longer diabetes duration at baseline. These subgroups also showed a higher prevalence of retinopathy and microalbuminuria.

Conclusion

Four subgroups with distinct HbA1c trajectories were identified. More than 90 % reached and maintained good glycemic control (subgroup one and two). Patients within the two subgroups that showed a more unfavorable course of glycemic control were younger, had higher HbA1c levels and a longer diabetes duration at baseline.

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Acknowledgments

We thank all general practitioners in the West-Friesland region for there obliging contributions to the study, the research assistants and staff of the Diabetes Care System for the enormous amount of work to collect all the data and the PHARMO network for the opportunity to compare the medication data. This project is supported by a Bridges grant from the International Diabetes Federation. Bridges, an International Diabetes Federation project, is supported by an educational grant from Lilly Diabetes.

Conflict of interest

G.N. received unrestricted grants from Novo Nordisk and Sanofi-Aventis and is member of the advisory board of Eli Lilly. For the other authors, no potential conflicts of interest relevant to this article were reported.

Ethical standard

All human studies have been performed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards lay down in an appropriate version of the 1964 version of the declaration of Helsinki.

Human and animal rights disclosure

All patients were informed on the use of the data for research purposes.

Informed consent disclosure

Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

    Iris Walraven, M. Ruth Mast, Trynke Hoekstra, A. P. Danielle Jansen, Amber A. W. A. van der Heijden, Simone P. Rauh, Femke Rutters, Esther van ’t Riet, Petra J. M. Elders, Annette C. Moll, Bettine C. P. Polak, Jacqueline M. Dekker & Giel Nijpels

  2. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

    Iris Walraven, Trynke Hoekstra, Simone P. Rauh, Femke Rutters, Esther van ’t Riet & Jacqueline M. Dekker

  3. Department of Ophthalmology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands

    Iris Walraven, Annette C. Moll & Bettine C. P. Polak

  4. Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands

    M. Ruth Mast

  5. Department of Health Sciences, Faculty of Earth- and Life-Sciences, VU University, Amsterdam, The Netherlands

    Trynke Hoekstra

  6. Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands

    A. P. Danielle Jansen, Amber A. W. A. van der Heijden, Esther van ’t Riet, Petra J. M. Elders & Giel Nijpels

Authors
  1. Iris Walraven
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  2. M. Ruth Mast
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  3. Trynke Hoekstra
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  4. A. P. Danielle Jansen
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  9. Petra J. M. Elders
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  10. Annette C. Moll
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  11. Bettine C. P. Polak
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  13. Giel Nijpels
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Corresponding author

Correspondence to Iris Walraven.

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Walraven, I., Mast, M.R., Hoekstra, T. et al. Distinct HbA1c trajectories in a type 2 diabetes cohort. Acta Diabetol 52, 267–275 (2015). https://doi.org/10.1007/s00592-014-0633-8

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  • DOI: https://doi.org/10.1007/s00592-014-0633-8

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