Premium
Longitudinal trends in HbA 1c patterns and association with outcomes: A systematic review
Author(s) -
Luo Miyang,
Tan Kristin Hui Xian,
Tan Chuen Seng,
Lim Wei Yen,
Tai EShyong,
Venkataraman Kavita
Publication year - 2018
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.3015
Subject(s) - medicine , longitudinal study , psychosocial , type 2 diabetes , diabetes mellitus , demography , disease , population , ethnic group , diabetes management , gerontology , environmental health , psychiatry , pathology , endocrinology , sociology , anthropology
Background This study aimed to review studies that identified patterns of longitudinal HbA 1c 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 HbA 1c 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 HbA 1c , and ( c ) analysis of the trend of HbA 1c 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 HbA 1c trajectory patterns. The most commonly identified patterns included stable HbA 1c around 7.0% and at levels between 8.0% and 9.9%, which usually captured the HbA 1c pattern among the majority of subjects in the study population. Unstable patterns identified included increasing HbA 1c trend, decreasing HbA 1c trend, and non‐linear patterns. These patterns were associated with differential risk of disease outcomes, over and beyond single‐point HbA 1c 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 HbA 1c pattern groups. Conclusion Common patterns of longitudinal HbA 1c 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.